Diagnostic and treatment methods

ABSTRACT

The present invention relates to a method of diagnosing the primary lesions that give rise to a chronic condition or incorrect structure in myofascial units and associated structures in a human patient. The invention also relates to a method of therapeutic treatment of the diagnosed conditions, in particular by application of a variable vacuum stimulus.

FIELD OF THE INVENTION

The present invention relates to a method of diagnosing the primarylesions that give rise to a chronic condition or incorrect structure inmyofascial units and associated structures in a human patient. Theinvention also relates to a method of therapeutic treatment of theabove-mentioned conditions.

BACKGROUND

The diagnosis of chronic conditions or incorrect structures inmyofascial units and associated structures in a human patient usuallyinvolves the elaboration of the medical history or anamnesis of thehuman patient by gathering information through questioning by aphysician either of the patient or of other people who know the patientand can give suitable information. The medically relevant complaintsreported by the patient or others familiar with the patient are referredto as symptoms. This information is complemented by the determination ofclinical signs, which are ascertained by direct examination on the partof medical personnel. The information obtained in this way enables thephysician to form a diagnosis and treatment plan.

Traditionally, once the lesion or incorrect structure has beenidentified the treatment plan focuses on restoring the normal functionof the structure primarily, although not exclusively, by directinteraction with the incorrect structure where the lesion is located.

Although this strategy provides relief in a number of instances it hasbeen reported that not all patients respond adequately to the treatmentof the diagnosed lesion or respond partially or respond to treatment butrelapse once treatment is finished or shortly afterwards.

DESCRIPTION OF THE INVENTION

The inventors have now surprisingly found that, limiting the treatmentto the restoring of the normal function of the structure associated withthe symptoms reported by the patient, provides suboptimal results and assuch, they have developed a new diagnostic technique that allowsidentifying the causes or primary lesions that give rise to the chroniccondition or incorrect structure (such as scoliosis, kyphosis, lordosisor limb dysmetria) that is the primary motivation for the patient'squest for medical attention.

In a first aspect of the present invention the new diagnostic technique(which the inventors have named Saló-Darder Methods or SD Method) isbased on the finding that individual myofascial units (and theirassociated joint articulations) form the links in a so-called myofascialchain. There are several myofascial chains which originate in the footand go to the cranium.

It is hypothesized that the state of stress in tissues (muscles,fascias, joints, nerves, blood and lymph vessels, organs, viscera),traumatic injury to these, or degenerative processes bring aboutretraction (muscular system) and adherences (fascial system), and/orscarring fibrosis which, in turn, cause limitation of movement(muscular, articular and fascial), as well as pain and inflammation(muscular, articular and fascial), and may be linked to stenosis in theaponeurosis of the vascular and nervous systems.

Faced with these limitations of movement, the individual makesunconscious muscular-articular-fascial compensations. Thesecompensations involve the intervention of tissue (muscles, fascias andarticular joints) tensional chains.

It has been found that when one of the links (at any point of the chain)comes under tension, a tensional chain is initiated. The link at whichthe tensional chain begins is called the “primary lesion”. The primarylesion will, in turn, tense all of the subsequent myofascial units(links) and articular joints in sequential order.

The provoked tension along the myofascial chain (starting from theprimary lesion) will create the so called “tensional chain”. This canlead to incorrect biomechanical compensations in the body, leading totension in the antagonistic muscles of the affected tensional chain,which will provoke a symptomatic lesion. This symptomatic lesion tendsto be the object of the consultation with a practitioner (such as aTraumatologist, a Physiotherapist or a Manual Therapist). Thissymptomatic lesion is most often found at the end of the tensional chaindistal from the primary lesion and it may occur as:

-   -   1. Muscular and fascial pain, inflammation and limitation of the        joint articulation movement, any other type of pain (reason for        consultation) distal from the initial pathological process        (primary lesion).    -   2. Stenosis in the vascular, lymphatic and nervous systems.

The SD method has identified eight potential tensional myofascial chains(and one local myofascial chain related to the scapula) which aredescribed in detail below.

Based on the above premises, when a patient explains the reason for hisvisit (usually localized pain) to the practitioner, the practitionermust rule out an injury chain that causes this pain. Otherwise, thetreatment applied to the affected area may be insufficient and cause arecurrence, due to the persistence of the injury chain.

Consequently, the principle of the Saló-Darder diagnostic system is thatit is necessary to locate the injury chain that might be responsible forcausing the injury giving rise to the visit and establish which tissues(muscles, fascia and joints) of the chain are affected by the primarylesion.

To identify the existence of an injury chain, the practitioner mustdetermine.

-   -   1. Firstly, which kinetic chain dominates the affected area        where the patient is reporting symptoms or which is identified        by the practitioner as the affected area.    -   2. Secondly, after locating the dominant kinetic chain, the        practitioner must identify which link (myofascial unit) has        given rise to the injury chain, known as the “primary lesion in        the injury chain” (or simply, the “primary lesion” or “site of        origin”).

The primary lesion exerts dominance over the other lesions and is thekey lesion to be treated in the first place. The SD Method lays down ageneral rule for identifying the primary lesion in each injury chain: ofall the myofascial units affected, the primary lesion will be the one inthe most caudal position (i.e., of all the links affected, the onenearest the foot will be the one giving rise to the injury chain). Thisprimary lesion must then be treated to restore it to its normalcondition.

In a second aspect of the present invention, a method of treatment isprovided comprising the following steps a) the practitioner identifiesthe primary lesion following the method described herein, b) thepractitioner treats the primary lesion c) the practitioner re-evaluatesthe injury chain and, d) in the event that symptoms persist thepractitioner identifies the new primary lesion (a different one sincethe first lesion will have been normalised) and eventually treats thenewly identified lesion. This process may be repeated as many times asnecessary. Nevertheless, in order to avoid the need of repeatedre-evaluations after every single treatment step, the practitioner mayalternatively decide to treat the complete injury chain starting fromthe primary lesion (the lesion in the most caudal position in the injurychain) and continuing with the treatment of the rest of the myofascialunits in the injury chain in the foot to head (caudal to cranial)direction. Thus, in an alternative embodiment of the present inventionthe method of treatment comprises the following steps a) thepractitioner identifies the primary lesion as hereinabove described andb) the practitioner treats the complete injury chain starting from theprimary lesion (the lesion in the most caudal position in the injurychain) and continuing with the treatment of the rest of the myofascialunits in the injury chain in the foot to head (caudal to cranial)direction.

In a third aspect of the present invention a method of treatment isprovided whereby lesions are treated using mechanical devices for theapplication of localized vacuum/pressure stimulus of variable intensity,such as a series of vacuum pulses, to the body areas to be treated.

DETAILED EXPLANATION OF THE FIGURES

FIG. 1 illustrates the flexion and extension movements used by thepractitioner to evaluate the state of a patient's neck.

FIG. 2 illustrates the inclination movements (tilting to the left and tothe right) used by the practitioner to evaluate the state of a patient'sneck.

FIG. 3 illustrates the rotation movements used by the practitioner toevaluate the state of a patient's neck.

FIG. 4 illustrates the improvement in the degree of flexion (measured indegrees) achieved by patients after 1 to 4 visits during which treatmentwas received.

FIG. 5 illustrates the improvement in the degree of extension (measuredin degrees) achieved by patients after 1 to 4 visits during whichtreatment was received.

FIG. 6 illustrates the improvement in the degree of tilting to the right(measured in degrees) achieved by patients after 1 to 4 visits duringwhich treatment was received.

FIG. 7 illustrates the improvement in the degree of tilting to the left(measured in degrees) achieved by patients after 1 to 4 visits duringwhich treatment was received.

FIG. 8 illustrates the improvement in the degree of rotation to theright (measured in degrees) achieved by patients after 1 to 4 visitsduring which treatment was received.

FIG. 9 illustrates the improvement in the degree of rotation to the left(measured in degrees) achieved by patients after 1 to 4 visits duringwhich treatment was received.

FIG. 10 the distribution of patients according to their VAS score(Visual Analogue Scale) at the first visit/treating session, the secondvisit/treating session, the third visit/treating session and the forthvisit/treating session.

FIG. 11 and FIG. 12 show an apparatus as described in WO 2011/101388which is used to carry out the treatments described in examples 2 to 8of the present application.

Numerals 1 to 25 appearing in FIG. 11 and FIG. 12 have the followingmeanings:

-   1 support device-   2 support member-   3 lower base portion-   4 supporting arms-   5 wheel carpet caster-   6 transverse reinforcing spacer-   7 arm structure-   8 and 9 parallel arms-   10 connecting member-   11 carrying bar-   12 and 13 hose connectors-   14, 15 and 16 air inlet hoses-   17 suction machine-   18 applicators-   19 suction means-   20 housing-   21 wheels-   22 control means-   23 display screen-   24 mount arm-   25 treatment assembly

FIG. 13 illustrates the shape of a single vacuum pulse according to apreferred embodiment of the present invention (described in pages 34 to35).

FIG. 14 shows a pulsating vacuum pattern (vacuum wave) applied in apreferred embodiment of the present invention (described in pages 34 to35) which comprises a series of pulses as shown in FIG. 13.

FIG. 15 illustrates an applicator (110) of the apparatus when brought incontact with a patient's skin in the course of a treatment according tothe present invention.

FIG. 16 shows in a schematic representation of the human body thelocation of the RMTC chain. The position of the LMTC is identical but onthe contralateral side of the body.

FIG. 17 shows in a schematic representation of the human body thelocation of the RLTC chain. The position of the LLTC is identical but onthe contralateral side of the body.

FIG. 18 shows in a schematic representation of the human body thelocation of the RATC chain. The position of the LATC is identical but onthe contralateral side of the body.

FIG. 19 shows in a schematic representation of the human body thelocation of the RPTC chain. The position of the LPTC is identical but onthe contralateral side of the body.

FIG. 20 shows in a schematic representation of the human body thelocation of the TSTC chain.

FIG. 21 and FIG. 22 show the positioning of the suction heads(applicators) during the first step of the treatment described inExample 2.

FIG. 23 and FIG. 24 show the positioning of the suction heads(applicators) during the second step of the treatment described inExample 2.

FIG. 25 and FIG. 26 show the positioning of the suction heads(applicators) during the third step of the treatment described inExample 2.

FIG. 27 shows the positioning of the suction heads (applicators) duringthe fourth step of the treatment described in Example 2.

FIG. 28 show the positioning of the suction heads (applicators) duringthe last step of the treatment described in Example 2.

FIG. 29 shows the VAS score (Visual Analogue Scale) used for theevaluation of pain.

FIG. 30 illustrates how the vacuum applicators may be displaced duringthe treatment of a myofascial unit to cover the complete extension ofsaid myofascial unit.

DETAILED EXPLANATION OF THE DIAGNOSTIC METHOD

The SD Method establishes that individual myofascial units (and theirassociated joint articulations) make up each of the links in amyofascial chain. The chain originates in the foot and goes to thecranium.

When one of the links (at any point of the chain) comes under tension, atensional chain is initiated. The link at which the tensional chainbegins is called the “primary lesion”. The primary lesion will, in turn,tense all of the subsequent myofascial units (links) and articularjoints in sequential order.

The provoked tension along the myofascial chain (starting from theprimary lesion) will create the so called “tensional chain”. This canlead to incorrect biomechanical compensations in the body; leading totension in the antagonistic muscles of the affected tensional chain,which will provoke a symptomatic lesion (this tends to be the object ofthe consultation with a practitioner (such as a Traumatologist, aPhysiotherapist or a Manual Therapist). This symptomatic lesion is mostoften found at the end of the tensional chain distal from the primarylesion, it may present as:

-   -   a) muscular and fascial pain,    -   b) inflammation and limitation of the joint articulation        movement,    -   c) any other type of pain (reason for consultation) distal from        the initial pathological process (primary lesion).    -   d) stenosis in the vascular, lymphatic or nervous system.

The SD method has identified eight potential tensional myofascial chainsand one local myofascial chain related to the scapula.

The potential tensional myofascial chain (from now on TC) originatesfrom the feet and inserts into the pelvis. At the pelvis, the TCcontinues or subdivides into two TC and terminates in the cervicalvertebrae and cranium region.

As mentioned before the SD method has identified nine potentialtensional myofascial chains: four Tensional Chains including the lowerright limb, four including the lower left limb and one related to thescapula. Each chain receives a different name according to itstopography and route:

-   -   1. Right Medial Tensional Chain (RMTC)    -   2. Left Medial Tensional Chain (LMTC)    -   3. Right Lateral Tensional Chain (RLTC)    -   4. Left Lateral Tensional Chain (LLTC)    -   5. Right Anterior Tensional Chain (RATC)    -   6. Left Anterior Tensional Chain (LATC)    -   7. Right Posterior Tensional Chain (RPTC)    -   8. Left Posterior Tensional Chain (LPTC)    -   9. Transverse Scapula Tensional Chain (TSTC)

The positions of the above-mentioned tensional chains (only those on thebody's right hand side) are illustrated in FIGS. 16 to 20. A detaileddescription of the above-mentioned Tensional Chains is found in thesection headed “SD Tensional Chains”

SD (Saló-Darder) Tensional Chains

Medial Tensional Chains (RMTC and LMTC):

From Foot to Knee

The Left and Right Medial Tensional Chains (LMTC and RMTC) comprise thedeep posterior compartment of the lower leg, where we find the flexorhallucis longus, flexor digitorum longus, posterior tibialis and thefascias of these muscles, the artery and veins of the posteriortibialis, the tibial nerve, and the peroneal artery and vein. Thesuperficial fascia (connective tissue of the dermis and the hypodermis),the saphenous nerve and vein, and the medial part of the superficialposterior compartment of the lower leg, also form part of the MTCs.Approximately one fifth of the medial fibres of the soleus and itsfascia, and the medial fibres of the medial head of the gastrocnemiusand its fascia also forms part of these tensional chains.

The MTCs originate at the foot, in the fascial and tendinous insertionsof the muscles which make up the medial compartment of the lower leg, itcontinues up through the medial border of the tibia, inserts into thesuperficial and deep posterior fascia on the medial border of the tibiaand merges with the periosteum. This fascia is reinforced by theaponeurotic expansions of the tendons of the sartorius, semitendinosusand gracilis muscles in the superior medial compartment of the tibia(pes anserinus).

When the MTCs are tensioned at the foot level the following may occur:

-   -   They may alter the correct neurodynamic of the tibial nerve,        through its passage in the deep posterior compartment of the        flexor muscles. This tension subjects the nerve to compression        and may cause mild neural stenosis. Although this stenosis is        generally asymptomatic it creates abnormal afferent and efferent        biofeedback reflexes in the endings of the calcaneal nerve,        medial plantar nerve and lateral plantar nerve. Said process        facilitates plantar fasciitis or calcaneal spurs; both of which        are difficult to resolve without previously resolving the        neurodynamic dysfunction.    -   A primary lesion in the MTCs can generate sustained tension        (mainly asymptomatic) at the flexor retinaculum of the foot;        this increased tension can generate the effects of stenosis in        the tarsal tunnel.    -   Increasing the coaptation of all articular foot joints, limiting        their movement and facilitating degeneration and painful        articular processes.    -   Pain (tendinous, synovial, neural, periosteal, retinacular or        vascular) frequently appears in the area underlying the flexor        retinaculum.    -   Manifestation of tension in the MTCs may be caused by a foot        with lax ligaments (pronated hind foot and mid foot in dynamic        movement). The dynamics of the foot can generate overuse of the        internal chain.    -   Increasing tension in the tarsal tunnel may lead to stenosis        around the underlying structures (tendinous sheath and tibial        nerve) and may lead to altered biofeedback to the plantar and        calcaneal nerves, both at afferent and efferent level.    -   It may favour a calcaneal varus.    -   Pronation in dynamic movement of the hind and mid foot generates        an overuse of the MTCs and puts the whole of the MTCs in tension        up to the pelvis.    -   Calcaneal spurs and plantar fasciitis (possible irritation of        the plantar nerve and of the calcaneal nerve in the tarsal        tunnel).

From Knee to Pelvis

At the level of the pes anserinus the MTCs connect to the posteriorTensional Chains (RPTC and LPTC, to be described later) via thesemitendinosus muscle.

The MTCs connect to the medial connective tissue structures of the knee(medial collateral ligament, meniscus medial, articular capsule,patellar tendon, medial patellar retinaculum, the patella and the localperiosteum) via the aponeurotic extensions of the tendons inserted inthe pes anserinus, and the extensions from superficial and deepcompartment of the lower leg and the tibial periosteum.

The MTCs continue their path upwards from the medial compartment of theknee, pes anserinus region (gracilis and sartorius) and the adductortubercle on the medial condyle of the femur. The aponeurotic expansionsof the adductor magnus, sartorius and gracilis muscles connect with themedial articular capsule and greatly influence medial movement of thearticular joint, the meniscus, the internal collateral ligament and themedial patellar retinaculum.

The MTCs goes up through the fascial compartments of the adductors. Thisnetwork of fascias extends from the adductor tubercle to the lineaaspera (medial lip) and up to the lesser trochanter, reaching theischiopubic ramus, the supra pubic region and the inguinal ligament. Ona muscular level, the MTCs are formed by the gracilis, sartorius,adductor magnus, adductor longus, adductor brevis, pectineus and theirrespective fascias. The blood vessels and nerves local to this region(great saphenous vein, femoral artery and vein, obturator nerve,saphenous nerve and medial branches of the femoral nerve which controlthe adductor muscles) form part of the MTCs.

The MTCs at the ischiopubic ramus and the fascias of the adductors haveelongations which interconnect to the local periosteum and to theperineal fascia; this fascia covers the muscles that make up the femaleand male perineum (anterior pelvic diaphragm). The perineal fasciasinterconnect with the different fascias in the region through theaponeuroses. Connections to note in these fascia include the aponeurosisof the levator ani muscle, urethral sphincter muscle, retrovesical orretroprostatic fascia, prostate, rectum, vagina, seminal vesicle,bulbourethral glands (Cowper's gland), greater vestibular gland, penis,scrotum, retropubic fascia, bladder, and finally the fascias of thesmall blood vessels and nerve branches.

Tension in the MTCs have a major impact on the pelvic diaphragm and theperineum: it can compromise its functioning, causing all class ofproblems in pelvic viscera as well as in local blood vessels and nervesbranches.

When the MTCs are tensioned at the knee level the following may occur:

-   -   Coaptation of the medial portion of the articular joint.    -   Limitation in medial and lateral rotation of the tibia with        respect to the femur.    -   Increased tension in the medial compartment. This will        subsequently cause dysfunction in the vascular system due to        stenosis; altering the mechanisms of the haemodynamics of the        articular joint.    -   Tension on the medial patellar retinaculum generates medial        displacement of the patella when the knee is flexed.    -   Increased thickness and sensibility of the medial collateral        ligament. The cause resides in an excessive demand on the        adductor magnus: this forces adduction from the internal femoral        condyle, which exercises a stress on the medial portion of the        knee, this in turn causes thickening of the medial collateral        ligament.    -   Early degeneration of the joint articulation. The most important        causes being medial articular joint coaptation generated by the        MTCs, limited joint movement, haemodynamic deficit due to        vascular stenosis and limited movement of the medial meniscus.    -   The MTCs facilitate meniscal pathologies of the medial meniscus,        due to tension exercised on the medial articular joint capsule.        This produces thickening of the medial collateral ligament and a        limitation of the movement of the tibia with respect to the        femur. All this generates a state of chronic suffering, both        symptomatic and asymptomatic; it can cause spontaneous rupture        to or increase degenerative changes in the meniscus.    -   Tension in the MTCs may be the cause of many types of knee pain.    -   Producing non-specific knee pain. The saphenous nerve forms part        of the MTCs. Commonly, when the MTCs are in tension, the        adductors and fascias compress the saphenous nerve creating        abnormal afferent and efferent biofeedback on the medial        compartment of the knee. This generates pain and hyperaesthesia.    -   Pain in the medial area of the knee is common once tension in        the MTCs has been established. The pain may present in any one        of the structures at that site: patella, meniscus, patellar        retinaculum lateral and medial, ligament, capsule, tendon        insertion, local nerves etc.    -   The femoral artery and vein pass through the hiatus of the        adductor magnus. Tension in the MTCs may compromise the hiatus        and can affect blood vessel functioning.    -   Fluid retention. The MTCs present numerous foramens for the        great saphenous vein, and also for small venous vessels and        lymphatic ducts. When tension is established in the MTCs it may        compromise venous return and lymphatic drainage.

When the MTCs are tensioned at the pelvis level the following may occur:

-   -   The MTCs increases coaptation and limits coxofemoral movement,        facilitating onset of degenerative articular joint processes.    -   Compromised saphenous vein hiatus, due to its dependence on the        laxity of the medial compartment. When tension exists in a MTC        there may be a mild or severe stenosis of the saphenous vein in        its hiatus. The most common symptoms depend on the seriousness        of the stenosis; ranging from slow and progressive fluid        retention in the lower limb to the appearance of small or large        varicose veins.    -   Generates a contralateral pelvic tilt with ipsilateral rotation.        For example, tension in the right side generates a left tilt of        the pelvis associated with a right rotation. This tilt is the        cause of many pelvic and lumbar scolioses.    -   Tension in the MTCs generates iliac anteversion. The hamstrings        (biceps femoris, semimembranosus and semitendinosus) are put        under tension as they are antagonists (they cause retroversion).    -   The MTCs house the superior and inferior inguinal ganglions.        When the cribriform fascia comes under tension, it causes        stenosis in the lymphatic ducts, thereby diminishing their        efficiency.

When the MTCs are tensioned at the perineum level the following mayoccur:

-   -   Urinary Incontinence (UI) due to dysfunction of the sphincter.        Tension in the MTCs generates laterocaudal traction on the        perineal fascia; this pulls the sphincter away from the urethra        causing a dysfunctional closure.    -   Local varicose veins (anus, vagina, testicle) caused by perineal        stenosis.    -   Masculine Impotency. All men who suffer from impotency manifest        tension in the MTCs. It is also associated with tension in the        PTCs: resolution of tensions in both these TCs helps improve or        resolve the problem.    -   Alteration in the vaginal mucus may occur, presenting excess        mucus or vaginal dryness (the latter causing dispareunia).    -   Anorgasmia. The tension subjected by the MTCs to the local        branches of the nerve may generate a deficiency in sensitivity.    -   The tension in the MTCs submit the perineal fascia to tension.        This, through transference, pulls on the retroprostatic and        retropubic aponeuroses of the prostate. In such a case, this may        compromise the haemodynamics. If this happens, prostate drainage        through the venous and lymphatic system will become compromised;        increasing hormonal stimulation time, which in turn facilitates        benign prostate hypertrophy and the presentation of associated        symptoms (post void dribbling and pollakiuria).    -   Compromised saphenous vein hiatus. A mild or severe stenosis of        the hiatus of the saphenous vein may occur when there is tension        in the MTCs. The most common symptoms depend on the seriousness        of the stenosis; from slow and progressive liquid retention in        the lower limb to the appearance of small or large varicose        veins.    -   Lymphatic retention. The cribriform fascia has numerous foramina        for the lymphatic ganglions and for the passage of the conducts.        When tension arises in a MTC the lymphatic ganglions and ducts        are compromised.    -   The femoral artery and vein run through the MTCs. Tension in the        MTCs will, at times, compromise their correct functioning due to        stenosis and is common to find symptoms of a circulatory origin:        venous insufficiency, heavy legs, pain or discomfort of        circulatory aetiology, or dysfunctional valves.        From Pelvis to Cervical Spine/Cranium

At the body portion ranging from the pelvis to the cranium both the LMTCand RMTC subdivide in a more external chain (the AATC) and a moreinternal one (the AVTC):

-   -   1. Anterior Abdominal Tensional Chain (AATC)    -   2. Anterior Vertebral Tensional Chain (AVTC)        Anterior Abdominal Tensional Chain (AATC)

The AATC continues via superficial fascia (scarpa and camper), rectussheath, muscles and fascias of the abdominal external oblique andinternal oblique, transverse abdominis, rectus abdominis, pyramidal,Cooper's ligament, and lacunar (gimbernat) ligament, median and medialumbilical ligaments. All of these are connected to the MTCs at theinguinal ligament and pubic symphysis.

The AATC ascends vertically in the space delineated by the anteriorsuperior iliac spine and the linea alba, until it reaches the musclesand fascias pertaining to the AATC in the periosteum of the ribs, thexiphoid process, the sternum, the major pectoral fascia and thediaphragm. Also forming part of the AATC is the vascular, lymphatic, andnervous system and the peritoneum of the area covered by the AATCs.

The AATC continues through the pectoral fascia and its insertions intothe sternum, manubrium, clavicle and humerus.

The pectoralis major muscle is rarely affected by tension in the AATC,as such, it is not considered a part of this tensional chain, but thepectoral fascia is. The pectoralis major muscle forms part of thetransverse scapular chain (TSTC).

The AATC terminates in the anterior and middle scalenes,sternocleidomastoid, sternothyroid and sternohyiod. It terminates inthis muscle group not because of a direct connective tissue relationshipbut because of the antagonistic effect that the AATC have on them. Forexample, when there is a tension present in the AATC (whether fromtension in a MTC or not), the AATC exerts a caudal traction on theanterior thoracic cage. This creates a strain on or an overexertion ofthe anterior and superior inspiratory muscles of the thorax. Theanterior and middle scalenes and also the sternocleidomastoid willbecome tense; this generates coaptation of the vertebral segment andwill frequently be symptomatic. The tension on the scalenes andsternocleidomastoid, generate, on a postural level and in the majorityof patients, an increased cervical lordosis and occipital extension.

When the ATC is tensioned at the perineum level the following may occur:

The most frequent cause of tension found in the AATC is tension in theMTCs. The AATC forms part of the MTCs, but when an MTC is tensioned thiscauses an anteversion of the iliac. This action is the contrary to thatcarried out by the AATCs; the latter acting as an antagonist(retroversion). To maintain this retroversion it uses the thoracicinsertions of the myofascial system pertaining to the AATC as a fixedpoint, generating a chronic caudal thoracic tension. Within the samechain we find established antagonisms between agonists and antagonists.

Possible Consequences of the Above Tensions:

-   -   Limited caudal movement of correct bucket and pump handle rib        movement. The thoracic cage shows severely limited rib        elevation. This leads to overuse of the muscles involved in        inspiration (thoracic diaphragm, intercostals, rib elevator        muscles, scalenes, and sternocleidomastoid) and they may be        symptomatic.    -   Generates a thoracic kyphotic posture, due to shortening of        abdominal muscles.    -   Acute or chronic pain, dorsal or lumbar contracture due to        antagonism. The tension in the AATC generates a constant tension        of abdominal and thoracic flexion; the extensor muscles of the        spine (antagonists) have to work to neutralize the AATC. If the        tension in the AATC is not deactivated pain will appear in the        extensor muscles of the vertebral column.    -   The increase of load on the scalenes and the sternocleidomastoid        (anterior inspiratory muscles), which generates tension in the        AATC, may produce a variety of symptoms: anterior and caudal        displacement of the cervical vertebral bodies (influences of        scalenes); increased cervical lordosis (influences of scalenes);        increased occipital extension (influences of        sternocleidomastoid); limited ipsilateral cervical rotation on        the side of the dominant AATC; and an increase in cervical and        occipital lordosis.    -   Increased cervical vertebrae coaptation and also increased        coaptation of the occiput on the atlas (influences of scalenes        and sternocleidomastoid).    -   Acute and chronic cervical pain, limited joint articulation        movement.    -   Vertigo and migraine.    -   Tension in the AATC increases the anterior load in the lumbar        and dorsal vertebrae which facilitates joint articulation        degeneration and disco pathology.    -   It may produce a stenosis in venous return and lymphatic        drainage causing slow and progressive fluid retention in the        abdominal area.    -   Increased pressure on the abdominal viscera and organs, leading        to diminished movement. For example, presenting symptoms may be        urinary continence caused by increased abdominal pressure which        causes greater pressure on the bladder and sphincter.    -   Having limited thoracic cage movement, the lungs and bronchioles        receive fewer stimuli for movement; debilitating them and        diminishing their efficiency. The increase in coaptation of        cervical and thoracic vertebrae and the occipital-atlas complex        contribute to the occurrence of stenosis in branches of the        autonomic nervous system (the vagus nerve, or the cervical        and/or thoracic sympathetic chain, or the efferent branches of        the intercostal muscles or the diaphragm controlled by the        phrenic nerve). This contributes to the debilitation of the        respiratory system and symptoms of bronchitis, asthma or        pneumonia may present.        Anterior Vertebral Tensional Chains (AVTCs)

The AVTCs are made up of the iliopsoas muscle and the iliac fascia, alsoall the blood vessels, nerves, lymphatic system, visceral system and theorgans related to the iliac fascia and its expansions, and also thediaphragmatic fascia.

The AVTCs, psoas and iliac fascia are connected to the MTCs at theinguinal ligament, iliopubic eminence, and to connective tissue of thefascia lata descending from the sartorius and to that of the pectineus.

When there is tension in the MTCs in the lower limb there will berepercussions in the AVTCs.

When the AVTC is tensioned the following may occur:

-   -   Generates iliac anteversion (influence of the iliac), with        increased lumbar lordosis (influences of the psoas).    -   Increases anterolateral coaptation of the lumbar vertebral        bodies. Forces disc protrusion and disc pathology, conducive to        formation of osteophytes in the anterior and lateral parts of        the vertebral body.    -   The AVTC forces lumbar flexion. Consequently, there is an        antagonism of the extensor muscles. These will act permanently        as antagonists until the tensions in the AVTC and/or MTCs are        deactivated.    -   Thickening or hypersensitivity of the inguinal ligament upon        palpation. The iliac fascia merges with the inguinal ligament.        The establishment of chronic tension in the AVTC generates        greater and constant tension on the ligament which facilitates        its thickening.    -   Stenosis in the branches of the lymphatic and vascular system,        also in any part in contact with the connective muscle system        that forms part of the AVTC.    -   Limited movement of the connective tissue related to the fascia        lata (such as the kidney fascia, blood vessels, nerves,        peritoneum, etc). It may provoke symptoms in the local viscera,        vessels or organs.    -   Tension in the AVTC generates a postural lumbar flexion, and        increased thoracic kyphosis.    -   The anteversion generated in the pelvis causes the AATC to act        as an antagonist. The muscles and the abdominal connective        system try to antagonize the movement and generate a retroverted        Tensional Chain. This is why tension found in an AVTC is always        accompanied by tension in the AATC, along with all the possible        consequences and symptoms previously described.    -   It is a tensional chain that generates the intense feeling of        physical and psychological fatigue in a patient. It generates a        mood state of sadness with poor decision making ability.    -   It has a strong influence on the diaphragm and the respiratory        system (blocking rib movement).        Lateral Tensional Chains (RLTC and LLTC)        From Foot to Knee

The LTCs run along the lateral side of the lower limb. They originate inthe foot, in the tendons and connective elongations of the peroneuslongus and brevis muscles. They are found in the lateral part of thefibular bone and are made up of the lateral compartment of the lowerleg, the peroneus longus and brevis muscles and their respectivefascias, the superficial peroneal nerve, one fifth of the externalsoleus and its fascia, the external part of the superficial posteriorcompartment and the superficial fascia (connective tissue of the dermisand hypodermis). The LTCs ascend the lateral part of the lower legsuntil they reach the fibular head where the peroneus longus muscle andthe lateral compartment of the lower leg insert having expansions to thelateral condyle of the tibia, passing in front of the tibiofibular jointarticulation. The lateral fibres of the soleus muscle insert into thelateral and posterior aspect of the fibular head. The lateral collateralligament connects the fibular head to the lateral femoral condyle.

When the LTCs are tensioned at the foot level the following may occur:

-   -   It alters the biomechanics of the foot. The patient manifests        pronation in dynamic movement. The LTCs are the cause of the        pronation; they misrepresent the pronation and shoe insoles        would be contraindicated.    -   Tension in the LTCs, via the tendinous insertions in the foot,        generates direct coaptation on the first and fifth        tarsometatarsal articular joints, this indirectly coapts the        second tarsometatarsal joint.    -   The patient presents stiffness in the fifth tarsometatarsal        articular joint: this is particularly observed when the patient        puts all their weight on the affected foot. It may lead to a        fracture of the fifth tarsometatarsal; especially in        sportspeople.    -   There is a dominance of the fibular bone; creating dysfunctional        movement.    -   Pain in tendons and synovial tissue.    -   Pain in local ligaments and periosteum.    -   When walking, forced dorsal flexion is shown to be limited and        is associated with medial rotation of the tibia, the fibula and        the knee complex (the patient loses the correct axis of knee        flexion). This movement produced by the LTCs on the foot and the        knee compromises the medial and anteromedial aspect of the knee.        From Knee to Pelvis

At femoral level, the LTCs continues along the iliotibial tract. Theyinsert into the anterior and lateral tibial condyles, merges with thefibulae, and send out connective expansions along the lateral aspect ofthe knees; superficial fascia, lateral patellar retinaculum, thepatella, the distal articular joint capsule. The LTCs ascend theiliotibial tract, merge with the tensor lata fascia, the connectivetissue of the iliac crest, gluteus medius, gluteus minimus and therespective fascias of these muscles.

When the LTCs are tensioned at the knee level the following may occur:

-   -   Pain and inflammation of the proximal tibiofibular articular        joint.    -   Pain in the tibialis anterior muscle, via the prolongations of        the iliotibial tract on the tibial fascia.    -   Limited articular joint movement of the tibia with respect to        the femur, both in medial and lateral rotation.    -   Lateral joint coaptation, increased joint degeneration,        facilitated degenerative processes.    -   The lateral collateral ligament (influences of the fibula)        deteriorates and is predisposed to thickening, having increased        tone and diminished flexibility.    -   Lateral displacement of the patella.

When the LTCs are tensioned at the pelvis level the following may occur:

-   -   Ipsilateral tilt of the pelvis.    -   Ipsilateral and contralateral rotation depending on the        dominance of either the posterior fibres of the gluteus medius        or the tensor of the fasciae latae.    -   Coapts and limits coxofemoral movement and facilitates        degenerative processes.    -   The tensed LTCs cause thickening of the gluteal aponeurosis.        These patients present stringy connective tissue along the iliac        crest. Treating the thickening present in the iliac crest is of        vital importance to deactivate the tension in the LTCs. If it is        not deactivated, treatment of the LTCs will not be effective and        the tension will reinstate.        From Pelvis to Cervical Spine

The aponeurosis and the gluteus medius muscles insert into the iliaccrests and the LTCs continue on through the muscles and fascias insertedin the iliac crests (external oblique muscle, internal oblique muscle,transversus abdominis, transversalis fascia, peritoneum, quadratuslumborum). From the iliac crests the LTCs extends along the lateralaspects of the abdomen, and the lumbar, thoracic and cervical area. Theyascend through the gaps formed by the iliac crests, quadratus lumborum,and lateral aspect of the thorax (intercostal muscles and fascias, ribs,lateral thoracic fascia and muscle and fascia of the serratus anterior).The LTCs terminate in the posterior scalenes.

The superficial fascia, nerves, blood vessels and lymph ducts form partof the LTCs and also those viscera and organs that contact the LTCs.

When the LTCs are tensioned the following may occur:

-   -   The LTCs produce ipsilateral thoracic flexion.    -   Increased lumbar lateral flexion (scoliosis)    -   Descended twelfth rib (influences of quadratus lumborum)    -   The interconnection of the renal fascia with that of the        quadratus lumborum may cause poor renal function leading to;        kidney stones, sand and kidney infection.    -   Tension in the quadratus lumborum generates a state of fatigue,        physical or psychological astenia, general mood of sadness or at        least emotional stress.    -   Tension in the right LTC causes a state of emotional frustration        and heightened sensibility which lead to moods of anger or fury.    -   Ipsilateral vertebral coaptation.    -   Generated antagonism of the contralateral LTC.    -   Tension in the LTCs generates caudal tension on the lateral and        posterior region of the thorax, especially via the external and        internal oblique muscles, transversus abdominis and quadratus        lumborum. This causes an overexertion of the lateral thoracic        inspiratory muscle group, which may be symptomatic. It is the        posterior scalene that most manifests symptomology (the anterior        and middle scalenes belong to the anterior abdominal chain)    -   As we saw earlier the LTCs block movement in the ribs and        thorax. This leads to decreased stimulation to the lung, pleura        and bronchioles, also to blood vessels and nerves in the area.        This blockage of movement may be conducive to respiratory        symptoms (such as mucous production or mucous and bronchial        irritation) and worsen illnesses (such as bronchitis, asthma or        pneumonia).    -   Acute and chronic cervicalgia (influences of the posterior        scalene)    -   Intercostal pain.    -   Respiratory difficulty.        Anterior Tensional Chains (RATC and LATC)

They cross the lateral aspects of the lower legs.

From Foot to Knee

They begin in the tendinous and fascial insertions of the extensormuscles of the feet and of the anterior compartment of the lower legs(comprising the tibialis anterior, extensor hallucis longus, extensordigitorium longus, peroneus tertius, anterior tibial vein and artery andthe deep peroneal nerve). The anterior compartment runs along the spacecreated between the anterior aspect of the tibia and fibula; theaponeurosis merges with the periosteum of the tibia and fibula; and theanterior crural intermuscular septum separates the ATCs from the LTCs.The muscles which form part of the ATCs insert into the tibial andfibular bones.

At the proximal end of the lower legs, the ATCs insert into the anteriorand lateral aspects of the tibial plateaus. On an aponeurotic level theymerge with patella tendons, the patellae, and the anterior and lateralaspect of the articular joint capsules. The ATCs have a directrelationship with the iliotibial bands (influence of LTCs), the lateralpatellar retinaculums, the tendons of the biceps femoris muscle(influences of PTCs), the periosteum and fasciae of the peroneal muscles(influence of LTCs). Tension in the ATCs is often the cause of a chronicproblem in the LTCs.

When the ATCs are tensioned at the foot level the following may occur:

-   -   Favours pronation in dynamic movement, with pes planus, and        favours medial rotation of the tibia and knee. This        dysfunctional movement arises when the antagonism of the        anterior chain is not efficient, especially in the lateral and        posterior chains. The antagonisms of internal tibial and fibular        rotation are not stable.    -   Coapts and limits the tibiotalar articular joint.    -   Anterior, medial and caudal traction on the fibula (influence of        the LTCs), especially by the musculofascial components of the        tibialis anterior and the extensor digitorium longus.    -   Coaptation generated in all articular foot joints.    -   Limited flexion movement.    -   When plantar flexion is tested on the supine lying patient        flexion in the knee occurs; associated with a medial rotation of        the whole of the lower limb.    -   The ATCs join the iliotibial bands via the tibialis anterior and        its fascia. The ATCs have a strong influence on the LTCs.        Tension in the ATCs often being the primary cause of a        symptomatic/asymptomatic LTCs.    -   Possible dysfunction of tibioperoneal ligaments.        From the Knee to the Pelvis

The ATCs ascend from the patellar tendons, the patellae and the anteriorarticular joint capsules up through the anterior compartments comingfrom the fascia latae, and from the quadriceps (vastus lateral, vastusintermedius, vastus medial, and rectus femoris).

When the ATCs are tensioned at the knee level the following may occur:

-   -   Dysfunction or pathological patellar processes.    -   Patellar tendinitis.    -   Coaptation and limited articular joint movement.    -   Traction on the fibular collateral ligament, which may be the        cause of chronic pain in said region.    -   The ATCs merge with the LTCs and may provoke many painful        symptoms both at knee level and at pelvic level.        From Pelvis to Cervical Spine/Cranium

The ATCs have little influence on structures above the pelvis,principally because there are few insertions in the iliac bones. Thesedo not have leverage as the main insertions are found in the femur andthese do not have the strength to modify pelvic parameters.

However, when the ATCs show a history of fibrillar rupture, then it hasan importance on pelvic structure. The process of fibre reconstructionsubsequent to fibre rupture may set off a retractile process in the ATCsand exert greater force on the iliac; facilitating anteversion. If thishappens, the tension continues along through the AATCs, and will perhapsshow any of the symptoms associated with tension in this TensionalChain.

Posterior Tensional Chain (RPTC and LPTC)

They cover the posterior aspect of the lower leg.

From Foot to Knee

They originate in the plantar aspect of the feet, in the tendinous andfascial insertions of the flexor digitorum brevis, abductor hallucis,abductor digiti minimi, flexor hallucis brevis and digiti brevi,lumbricales, quadratus plantae, the plantar ligaments, the plantaraponeurosis, the lateral band of the aponeurosis plantar, and theoblique head of the adductor hallucis.

The PTCs continue along the calcaneal tendons, the muscles and fasciasof gastrocnemius (the medial fibres of the medial gastrocnemiuscorrespond to the CTI) and the soleus (except for one fifth of themedial and lateral fibres which correspond to the MTC and the LTCrespectively); via the deep posterior compartment of the lower leg(except for one fifth of the medial and lateral fibres which correspondsto the MTC and the LTCs), and via the popliteus muscle and plantarismuscle. The fascial extensions of the gastrocnemius, soleus andpopliteus muscles merge with the posterior periosteum of the femoralcondyle, tibial plateau and the posterior articular joint capsule of theknee.

The superficial fascia makes up part of the PTCs, as do the neural,lymphatic and vascular systems extending through the area of theaforementioned compartments and muscles. Of note; the minor saphenousvein, the posterior tibial arteries and veins, the tibial nerve, thecalcaneus, the plantaris and sural muscles, also the posterior andterminal branches of the saphenous nerve.

Interconnections of the PTCs:

-   -   The central fibres of the soleus join the MTCs via its medial        fibres; on the external aspect, the medial fibres join the LTCs        via the lateral fibres of the soleus.    -   When the tibial nerves perforates the soleal hiatus and enters        the deep posterior compartment they join the MTCs.

When the PTCs are tensioned at the feet level the following may occur:

-   -   Plantar fasciitis.    -   Calcaneal spurs.    -   Achilles tendinitis.    -   Dorsal flexion limitation.        From Knee to Pelvis

The fascias of the medial gastrocnemius connect with the semimembranosusand semitendinosus muscle in the popliteal region; the lateralgastrocnemius merges with the biceps femoris. The PTCs ascend throughthe fascial system and superficial compartments of the hamstrings up tothe pelvis. This muscle unit and its fascia insert into the ischium. Theposterior portion of the hamstrings fascia merges with the gluteusmaximus fascia (anterior portion and the end of the inferoposteriorportion). The superficial fascia of the hamstrings merges directly withthe superficial fascia of the gluteus maximus.

At the pelvis, the PTCs continue along the gluteus maximus and theunderlying muscles (piriformis, pirimidalis, gemellus superior andinferior, obturatus externus and internus, quadratus femoris). The PTCsreach the posterior iliac spine and also the anterior and posteriorsacrum via the piriformis and the gluteus maximus (it joins the LTCs viaits insertion in the iliotibial bands). The pelvic muscles of the PTCsjoin the greater trochanter and the femur.

The PTCs is of great importance in the posterior pelvis on aneurodynamic level, of particular importance; the sciatic nerve, thepudendal nerve, the posterior femoral cutaneous nerve and the superiorand inferior gluteal nerves. The sciatic nerves are dependent on thePTCs up to the popliteus muscles: here, the peroneal nerves, once abovethe head of the fibulae, will be dependent on the LTCs. The tibialbranches are dependent on the PTCs until they pass the soleal hiatus.When the tibial nerves enter the deep posterior compartment they aredependent on the MTCs.

The PTCs are of great importance on a lymphatic level in the poplitealfossae, where the popliteal lymphatic nodules are found. These aredependent on the PTCs.

The posterior pelvic diaphragm forms part of the PTCs, thanks to theinterconnections of the connective system of the hamstrings in theischial tuberosity and the gluteus maximus in its insertion in thesacrococcygeal symphysis. The two extensions communicate through theconnective tissue system with the muscles of the posterior pelvicdiaphragm (levator ani, ischiococcygeus and obturator internus muscles)and the anococcygeal ligament. PTCs control of the pudendal nerves makesthese TCs ones of the most important in the pelvic diaphragm and forproper functioning of the perineum.

Interconnections of the PTCs:

-   -   Merges with the LTCs when inserting the iliotibial bands via the        gluteus maximus muscles.    -   Merges with the MTCs in the pes anserinus via the semitendinosus        muscles.    -   Merges with the LTCs at the fibular heads via the biceps femoris        muscles.    -   Merges with the vertebral PTCs (VPTC) via the gluteus maximus        and the piriformis muscles.

When the PTCs are tensioned at the knee level the following may occur:

-   -   Stenosis in the lesser saphenous veins.    -   Stenosis in the popliteal lymphatic nodules.    -   Delays post operative recovery time in the knees; particularly        oedema and haematoma. The PTCs control a large part of knee        drainage.    -   Increase in the degenerative articular joint processes of the        knees; both the gastrocnemius and the hamstrings are posterior        joint coaptors. Their tendofascial insertions merge with the        periosteum and the articular joint capsules: the tension created        in these structures causes stenosis in the vascular system. It        increases joint coaptation, with limited rotation of the tibial        plateau with respect to the femur.    -   It may initiate compression on the neural and vascular systems        in the region, generating symptoms specific to compression of        these nerves and veins (tibial nerve, cutaneous sural nerve,        peroneal nerve or lesser saphenous vein and posterior tibial        veins).

When the PTCs are tensioned at the pelvis level the following may occur:

-   -   Iliac and sacral retroversion (contranutation).    -   Contralateral pelvic rotation.    -   Homolateral lateral flexion (sidebending).    -   Stenosis of the sciatic, pudendal, posterior cutaneous femoral,        superior and inferior gluteal nerves.    -   Changes in tension in the posterior pelvic diaphragm. This is        often associated with pudendal stenosis, causing dysfunctions in        sphincter, urethra, anus, blood vessels, and pelvic viscera        (ovaries, prostate, bladder, fallopian tubes, uterus . . . )        functioning. Hence, the following problems may appear: urinary        and faecal incontinence, uterine myoma, endometriosis, altered        lubrication and sensitivity in the vagina, altered vasculature,        benign prostate hypertrophy, post void dribbling, impotence,        anorgasmia etc.    -   Dysfunction of the sacral autonomic nervous system (ANS). Both        the gluteus maximus and the piriformis muscles insert into the        sacrum; one in the anterior aspect and the other in the        posterior aspect. Both can create tension on the ANS leading out        of the sacrum, altering biofeedback and causing symptoms related        to abnormally stimulated nerves, i.e., as occurs with an over        stimulated bladder. Tension in the PTCs may generate all types        of dysfunction (in viscera, blood vessels and lymphatic ducts,        glands or sphincters) in the pelvic system.        From Pelvis to Cervical Spine and Cranium

They are made up of the following muscles and their fascias:

-   -   Longissimus, iliocostalis, spinalis.    -   Posterior and middle thoracolumbar fascia (not the anterior        lamina, which belongs to the LTC).    -   Multifidus, levatores costarum, rotatores spinae longus and        brevis, interspinales, intertransversarii.    -   Connective tissue (fascias, ligaments, tendons) which insert in        the sacral spinal apophyses, lumbar, dorsal and cervical        vertebrae, and terminates in the external occiput protuberance        (nuchal ligament, supraspinal and infraspinal ligaments)    -   Posterosuperior and inferior serratus.    -   Trapezius and rhomboids.    -   Splenius capitus and cervicus, longissimus capitus.    -   Semispinalis capitus, rectus capitus posterior major and minor,        inferior and superior obliquus capitus.

The PTCs enter the pelvis where they insert in the ischium, posterioraspect of the sacrum, coccyx, iliac crests and posterior iliac spinesvia the muscles and fascias of the hamstrings and gluteus maximus. Thegluteal fascial system joins the connective tissue of the iliocostalis,longissimus and spinalis muscles and the thoracolumbar fascia,connecting with it to give continuity to the posterior tensional chain.It extends through the topography of the muscles and fascias pertainingto the PTCs.

The PTCs terminate in the superior and inferior nuchal lines, posterioraspect of the mastoids, via insertions from the trapezius, spleniuscapitus, longissimus capitus muscles and suboccipital muscles.

On a neurological and vascular level the dorsal nerve branches andspinal blood vessels make up part of the PTCs.

When the PTCs are tensioned at the vertebral level the following mayoccur:

When there is tension present in a PTC, at lower limb level, thehamstrings and gluteus maximus generate retroversion of the iliac and ofthe sacrum (contranutation) with an increased posterior stretch on thelumbar vertebrae. The multifidi muscles and erector muscles of the spineact as antagonists. Hence, when there is tension in a PTC in the lowerlimb this leads to tension in the PTC at lumbar level. This is due,initially to the relationship with the fascial system and then, due tothe biomechanical antagonism it has with respect to the movements of theiliac, sacrum and lumbar vertebrae. The PTC generates chronic lumbago.

-   -   Fascial or muscular pain, in any part of the PTCs vertebral        area. For example; lumbalgia, dorsalgia or cervicalgia.    -   Vertebral articular joint pain. The erector muscles of the spine        are posterior vertebral coaptors. Increased tone generates        tension and/or posterior vertebral coaptation on the spinal and        transverse apophyses, joint faces and invertebral disc, and        limits vertebral rotation and flexion.    -   Neuropathic pain. Tension in the PTCs at vertebral level (VPTCs)        can generate neuropathic pain in two ways:        -   Muscular and fascial tension may compress the dorsal branch.        -   Increased joint coaptation may diminish or compress the            invertebral foramen and compress the perineural or dural            sheath.    -   Descended glenohumeral joint articulations. This problem appears        when there is a dominance of the inferior trapezius fibres and        the latissimus dorsi muscle in the VPTCs.    -   It can increase lordosis at lumbar and cervical levels.    -   Costovertebral pain. Principally initiated by the iliocostalis        muscles (caudal coaptors).    -   Tension in the iliocostalis muscle induces limited inspiration        due to caudal traction on the ribs; this generates overuse of        the posterior inspiratory muscles (superior posterior serratus,        intercostals and levatores costarum).    -   The erectors of the spine terminate in the cervical vertebrae,        the trapezius and the semispinalis muscles at the nuchal line,        and generate cervicalgia associated with limited articular joint        movements    -   Migraine, due to tension in the trapezius and suboccipital        muscles, which cause stenosis, principally, in the greater        occipital nerve.    -   Tension in the VPTCs generates limited vertebral flexion and        generates flexion in group block with a loss of posterior        stretch.        Transverse Scapular Tensional Chain (TSTC)

This chain is made up of the muscle and fascias which are involved inshoulder abduction and adduction, whether or not they insert into thescapula itself.

It is a TC which strives against the scapular adductors and abductors tomaintain its position. For example, when there is tension in a scapularmuscle abductor, the muscles involved in the opposite action (adduction)enter in an antagonism to maintain the position of the scapula.

Muscles of the TSTC which participate in scapular abduction:

-   -   Anterior deltoid.    -   Pectoralis major.    -   Serratus anterior.

Muscles of the ECTC which participate in scapular adduction:

-   -   Trapezius (middle fibres).    -   Rhomboids.    -   Levatator scapulae.

If we want to definitively resolve a specific tension in any muscle inthis chain we have to analyse its antagonist to find out whether it isaffected or not.

The topographies of all the previously mentioned Tensional Chainsinclude as integral parts of the Tensional Chain; the dermis,hypodermis, nerves, blood vessels, lymph ducts, glands, tendons,fascias, periosteum-tendon unions, periosteum fascias and theperiostio-aponeuroses of the muscles mentioned or any other structurepresent in the human body in the region of where the Tensional Chainpasses.

As mentioned earlier, all the tension in a Tensional Chain stems from aprimary lesion which is often non-symptomatic. The identification of themyofascial chain involved, its assessment, the identification of theprimary lesion (point of origin) and the treatment of at least theprimary lesion will be key to a successful symptomatic treatment.

Thus, one step in the SD method is to identify with precision the stateof tension or health of the myofascial and joint units constituting thetensional chain to which the lesion or condition associated with thesymptoms reported by the patient belongs.

The Saló-Darder evaluation method (SD method) involves the followingsteps:

-   -   Exploration of the state of the muscle and fascia (hereinafter,        myofascial unit) and the effect the myofascial unit has on the        joint, and    -   Evaluation using a rating scale of the following features:        -   the state of tension or health of the myofascial unit itself        -   the existence of tension exerted on the joint by the            myofascial unit or units (dominating the joint), i.e.,            whether the joint is subject to tension, joint coaptation,            vascular stenosis or stenosis of the periarticular nerve            caused by the retractile process of the myofascial unit or            units that are inserted into the joint.

To undertake the above-mentioned evaluation a 4-step approach isfollowed:

-   -   1. the patient is placed in the correct position to permit the        evaluation to be made.    -   2. the anatomical location of the evaluation point(s) to be        examined in the myofascial unit is/are located as described        below and the fingers are positioned at the evaluation point(s).    -   3. the direction of movement of the evaluation points is        determined and it is compared with the normal direction of        movement for the corresponding myofascial unit in healthy        conditions.    -   4. the degree of tension and mobility of at the myofascial unit        or joint being evaluated is determined.

We will now look at each of these elements in greater detail:

Step 1. Placing the Patient in the Correct Position for Making theEvaluation.

The position in which the patient must be placed to make the evaluationis of primary importance. Each myofascial unit or joint to be evaluatedrequires the patient to be in the correct position for the myofascialunit to be examined to be stretched. There are three types of position:standing, sitting or prone.

If the patient is not in the correct position the evaluation may not beeffective. The section entitled “Position of the patient and stretchingmaneuver based on the evaluation point” describes the correct anatomicalposition of the patient, depending on the myofascial unit and jointwhich are to be evaluated.

Step 2. Anatomical Location of the Evaluation Point in the MyofascialSystem and Positioning of the Fingers on the Evaluation Point.

The SD method has created the “evaluation point” that is required tomake the evaluation. Consequently:

-   -   each myofascial unit has its own evaluation point which is        located in a precise and specific site in the myofascial unit.    -   the evaluation points of each joint coincide with the evaluation        points of each myofascial unit that dominates the joint.

The SD method has designed a body map on which all the myofascial andjoint evaluation points are indicated.

After locating the evaluation point, the practitioner touches themyofascial unit to be evaluated with his hand, keeping his fingers onthe evaluation point at a precise angle (which depends on eachevaluation point). This way, he can evaluate the movement of theevaluation point when the patient stretches the fascia, as described inthe next phase.

Step 3. Observing the Direction in which the Evaluation Points Move.

Once the patient is in the correct position (sitting, prone, standing)and the practitioner has established digital contact with the evaluationpoint, the patient is asked to make a movement, in order to stretch themyofascial unit that is being evaluated and observe whether the movementof the evaluation point (i.e., the fascia) is correct or limited whenthe myofascial unit is stretched.

Step 4. Determining the Severity of the Lesions at the Myofascial Unitor Joint being Evaluated.

To evaluate the severity of a lesion the following aspects need to beassessed: a) the muscular tension, b) the myofascial mobility and c) themobility of the superficial fascias with respect to the myofascial unitevaluation. The different aspects are explained in detail below:

a) Muscular Tension Assessment.

The practitioner palpates the myofascial unit and compares themyofascial tension with its counterpart on the other side of the body.The degree of myofascial tension (MT) is assigned according to thefollowing 4-grade scale: Grade 3: Severe muscular tension withinflammation and pain on palpation; Grade 2: Significant musculartension with no inflammation and no pain on palpation; Grade 1: Moderateto mild muscular tension with no inflammation and no pain on palpation;and Grade 0: Same tone as its healthy counterpart on the other side ofthe body: the myofascial unit is pliable.

b) Myofascial Mobility Assessment.

The practitioner stretches the myofascial unit to evaluate its range ofmobility, elasticity and/or range of movement of the dominantarticulation. The degree of myofascial mobility is assigned according tothe following 4-grade scale: Grade 3: the myofascial unit presentssevere stretch limitation or shows an incorrect movement upon beingsubjected to a small tension, Grade 2: the myofascial unit presentssignificant stretch limitation or shows an incorrect movement upon beingsubjected to an intermediate degree of tension, Grade 1: the myofascialunit presents moderate stretch limitation or shows an incorrect movementupon being subjected to full tension, Grade 0: no observable stretchlimitation.

c) Mobility of Superficial Fascias with Respect to the Myofascial UnitAssessment.

The assessment is conveniently made using the device described ininternational patent application WO 2011/101388 A1, or other devicescapable of applying vacuum/pressure or to achieve similar results withother means. The vacuum devices (including the one described in WO2011/101388 A1) allow the application of suction to the area beingassessed. To effect the assessment the practitioner places theapplicator (110) on the area to be assessed. Then suction is connectedand while the suction forces grips the hypodermic fascias thepractitioner tries to move the applicator in 8 directions parallel tothe skin plane (north, northeast, east, southeast, south, southwest,west and northwest). When adhesions between the superficial fascias andthe underlying myofascial unit exist the practitioner is capable ofsensing a resistance to the movement in one or more of the 8 directionswhich indicates the presence of adhesion between the different fascialplanes. Conversely, when no resistance to movement is sensed and thefascias move correctly, this indicates that there are no adhesionsbetween the planes (superficial fascia and myofascial unit).

Stretching Maneuver and Patient's Position, Depending on the EvaluationPoint

As described above, each evaluation point requires the performance of aspecific type of stretching maneuver to determine the extent of thestate of tension or health of the myofascial unit. The stretchingmovements are detailed below for the different evaluation points:

1. Hip Flexion (Standing):

-   -   a) EP (evaluation point) fascia and muscles in the posterior        region of the thoracic, lumbar and sacral sections of the spine.    -   b) EP fascia and muscles in the posterior hip region.    -   c) EP fascia and muscles in the lateral and posterior hip        region.    -   d) EP fascia and muscles in the posterior femoral region.    -   e) EP fascia in the posterior knee region.

2. Hip Extension (Standing):

-   -   a) EP fascia and muscles in the anterior abdominal region.    -   b) EP fascia and muscles in the anterior hip region.    -   c) EP fascia and muscles in the lateral and anterior hip region.    -   d) EP fascia and muscles in the medial femoral region.    -   e) EP fascia and muscles in the anterior femoral region.    -   f) EP fascia and muscles in the lateral femoral region.

3. Stretching of Abdomen (Prone), with Maximum Inspiration:

-   -   a) EP fascia and muscles in the anterior abdominal region.    -   b) EP fascia and muscles in the diaphragm region.    -   c) EP fascia and muscles in the inferior thoracic region.

4. Stretching of Thorax (Prone), with Maximum Thoracic Inspiration:

-   -   a) EP fascia and muscles in the thoracic region.

5. Knee Flexion (Prone):

-   -   a) EP fascia and muscles in the anterior femoral region.    -   b) EP fascia and muscles in the knee.    -   c) EP fascia and muscles in the patella.    -   d) EP fascia and muscles in the tibial plateau region.

6. Foot Flexion (Standing).

-   -   a) EP fascia and muscles in the anterior leg region.    -   b) EP fascia and muscles in the lateral leg region.    -   c) EP fascia and muscles in the posterior leg region.    -   d) EP fascia and muscles in the medial leg region.    -   e) EP fascia and muscles in the posterior knee region.

7. Lumbar Glexion (Standing).

-   -   a) EP fascia and muscles in the lateral and posterior trunk        region.    -   b) EP fascia and muscles in the lateral trunk region.    -   c) EP fascia and muscles in the lateral and anterior trunk        region.    -   d) EP fascia and muscles in the lateral thoracic region.

8. Cervical Flexion (Standing, Prone or Sitting).

-   -   a) EP fascia and muscles in the lateral cervical region.    -   b) EP fascia and muscles in the muscles of the upper thoracic        region and upper scapular region.

9. Cervical Flexion (Standing, Prone or Sitting).

-   -   a) EP fascia and muscles in the posterior cervical region.

10. Cervical Extension (Standing, Prone or Sitting).

-   -   a) EP fascia and muscles in the anterior cervical region.

11. External Rotation and Abduction of the Glenohumeral Joint (Prone,Sitting, Standing).

-   -   a) EP fascia and muscles in the anterior thoracic region.

12. Flexion of the Glenohumeral Joint (Prone, Sitting, Standing).

-   -   a) EP fascia and muscles in the posterior glenohumeral region.    -   b) EP fascia and muscles in the scapular region.

We will now take a look at the types of treatment that can be applied toinjury chain lesions.

Detailed Explanation of the Method of Treatment

Treatment of the lesions intervening in the injury chain is performed bycarrying out one or more of the following correcting actions, dependingon the type of lesion:

-   -   1. Decontraction of muscles and fascia.    -   2. Relieving tension in the muscle and fascial fibres.    -   3. Relaxing the sarcomerus.    -   4. Stretching and moving the different muscle and fascial        planes.    -   5. Recovery of joint movement parameters.

In the context of the present invention a lesion is identified as analteration of a myofascial unit whereby said myofascial unit presentsone or more of the following characteristics a) abnormal musculartension, b) limitation of the myofascial mobility and c) limitation ofthe mobility of the superficial fascias

According to one aspect of the present invention the treatment of eachlesion is advantageously effected using mechanical devices for theapplication of localized vacuum/pressure stimulus of variable intensity,such as a series of vacuum pulses, to the body areas to be treated. Inparticular, the use of the device described in international patentapplication WO 2011/101388 A1, which is hereby incorporated by referencein its entirety, has proved to be specially convenient and effective fortreating the lesions (such as, for example the primary lesions) and thisconstitutes an embodiment of the present invention. This devicecomprises a suction machine having suction means for applying vacuum toa patient (e.g. according to several possible vacuum patterns) throughat least one applicator (110). Advantageously, this device makespossible treating patients by sanitary and cosmetic professionalpersonnel at any position on a stretcher, in a wheelchair or evenstanding up and in general in situations where he/she has to be treatedby said device.

The device has several suction cups or applicators (110) connected totheir respective hoses which are in turn connected to a device capableof generating negative pressure. In this way the suction cup facilitatethe application of vacuum to any selected portion of the patient's body.In addition, the practitioner when bringing the suction cup in contactto any given portion of the patient's body may also exert force on thesuction cup thereby creating a positive pressure in the areas where thewalls of the suction cup get into contact with the patient body. In thisway it is possible to combine positive pressure (exerted by the walls ofthe suction cup) with negative pressure (vacuum applied through thecup-hose system).

In a particularly advantageous embodiment of the present invention thetreatment of the lesions may be carried out by applying to the area tobe treated a pulsating vacuum stimulus for a period ranging from 1minute to 3 hours, for example using a suitable device such as the onedescribed in WO 2011/101388 A1.

The vacuum stimulus that will help massaging and moving different tissueplanes at the treated zone is a stimulus of variable intensity such as aseries of vacuum pulses. The vacuum is created through negative pressureand is applied to the area in need of treatment in the form of apulsating pattern through one or more applicators. The pulsating patterncomprises a series of pulses regularly spaced apart in time wherein amaximum vacuum force (MAXIMUM VACUUM) is applied to the area beingtreated for a first predetermined time period (PULSE LENGTH). Themaximum vacuum force is reached progressively along a second time periodcalled TIME UP After the maximum vacuum force is reached it ismaintained during a PULSE LENGTH and then the vacuum is decreased to asecond value (MINIMUM VACUUM) during a third time period (TIME DOWN).The MINIMUM VACUUM is then maintained for a fourth time period(RELAXATION TIME). Afterwards a new pulse begins and several pulses areapplied forming a treatment wave with a total duration designated astotal wave time. This pulsating vacuum pattern is illustrated in FIGS.13 and 14. In one particular embodiment it is also possible that theMINIMUM VACUUM takes a negative vacuum value i.e. that during theRELAXATION TIME a positive pressure is applied. The vacuum stimuli areconveniently applied through suction cups or applicators (110) which,upon application onto the patient's skin in the area to be treated,cover a certain area of the skin (i.e. the area encompassed within theperimeter defined by the applicator's perimetral rim). Depending on thesize of the area to be treated applicators of different sizes may beused. In one embodiment of the invention the applicators may defineareas of 17 cm², 42 cm² and 72 cm². The size of the applicator used fora given treatment will depend on the extension of the area to betreated. As a general rule the larger applicator is selected that can beapplied to the area to be treated in such a way that the applicator'sperimetral rim is fully contacted with the patient skin so that no airis allowed to enter the applicator when vacuum is turned on. As anexception to the former rule when a treatment is to be applied to a scarthe smaller applicator is used first,

The sloped trapezoidal profile of the individual pulses applied has beenshown to be particularly advantageous since the progressive vacuumincrease from the MINIMUM VACUUM value to the MAXIMUM VACUUM value andthe progressive decrease from the MAXIMUM VACUUM value to the MINIMUMVACUUM value allows to apply the vacuum treatment in such a way that thesensation of discomfort experienced by the patient is minimized. Thismay allow for the application of more intense vacuum and/or theapplication of vacuum for longer time periods resulting in an enhancedtreatment.

The application of suction (vacuum) with the help of the applicator(110) results in the movement and stretching of the tissue wherein thecentral portion of the tissue zone where the applicator is applied willbe subjected to the highest stretch in the direction of the vacuum whilethe points where the perimeter of the applicator (110) contacts the zonewhere it is applied will either not be stretched in the direction of thevacuum (when the applicator is simple contacted to the patient skinwithout applying any pressure) or will be stretched in an oppositedirection (if the applicator is applied to the skin exerting a certainforce). This is illustrated in FIG. 15:

1. THE POINT OF GREATEST MOBILIZATION (or maximum stretch in thedirection of the vacuum is located at the center of the applicator. Thisis the area where the greatest movement of tissue planes, greatesttissue stretch and greatest tissue massage of tissue layers is producedvia the force of suction of the vacuum created.

2. THE FULCRUM POINTS are located in at the perimeter of the applicatorcontacting the skin. The tissue in contact with the perimeter of theapplicator receives a positive force towards the skin.

The result is a stretch tension produced due to the force of negativesuction. The cutaneous tissue and superficial fascias nearest to theFULCRUM POINT are those that most relax.

The application of vacuum to the zones to be treated as explained aboveresults in one or more of the following benefits:

Summarizing a correct combination of the 6 control parameters asexplained in detail below for different type of treatments permits theconfiguration of a large number of massage effects (generally with thefixed arms of the terminal) as well as specific work for themobilization of localized tissue (generally with the mobile arms, butalso with the fixed arms). All these parameters are adjustable at alltimes by the practitioner without needing to stop the massage beingapplied by the apparatus.

These massage effects can be applied on:

-   -   The muscular and Fascial system    -   The articular system    -   The connective tissue system    -   The venous system    -   The lymphatic system    -   Microcirculation    -   Fibrosis/adhesions        Treatment of the Muscular and Fascial System:    -   1. Decontraction of muscles and fascia.    -   2. Relaxation of tension in muscle and collagen fibres.    -   3. Relaxation of the sarcomere.    -   4. Increase in the pliability of the connective and muscular        system.    -   5. Massage, stretch and mobilize the different muscular and        fascial planes.    -   6. Drainage of toxic metabolites.    -   7. Increase muscle recovery after physical exertion.    -   8. Achievement of local anti-inflammatory effects.    -   9. Increase of tissue regeneration after fibre rupture.

In a further aspect of the invention, once the tensional chain affectedand the primary lesion have been identified, the practitioner willproceed to treat the primary lesion. After treating the primary lesionthe practitioner should re-evaluate the entire injury chain and, in theevent that symptoms persist at any point of the tensional chain, thepractitioner must identify the new primary lesion (a different one fromthe first lesion which has already been treated and normalised) and willeventually treat it. This process may be repeated as many times asnecessary. Nevertheless, in order to avoid the need of repeatedre-evaluations after every single treatment step, the practitioner mayalternatively decide to treat the complete injury chain starting fromthe primary lesion (the lesion in the most caudal position in the injurychain) and continuing with the treatment of the rest of the myofascialunits in the injury chain in the foot to head direction.

The precise nature of the treatment applied according to the presentinvention will depend on the assessment of a) the muscular tension, b)the myofascial mobility and c) the mobility of the superficial fasciaswith respect to the myofascial unit evaluation as explained above.

When both myofascial mobility and muscular tension have been assigned toGrade 0 the myofascial unit is considered to require no treatment.

If either myofascial mobility or muscular tension assessments have beenassigned to Grade 2 or Grade 3 a two-phase treatment is indicated asdescribed below:

Phase 1 (Relaxed Position/Stretch Treatment):

The aim of this phase is to reduce muscular tension, increase range ofmobility to a Grade 1 value. After achieving this goal, phase 2 iscarried out.

In Phase 1 the practitioner operating the device described in WO2011/101388 A1 positions one or more applicators (using a fixed ormobile arm depending on which myofascial unit is being treated) upon themyofascial unit to be treated, in order to apply the treatment dosage.At the same time, using the other hand, the practitioner repositions themyofascial unit being treated using relaxed position and stretchmovements. The entire area of the myofascial unit has to be treated withthe applicator while the practitioner performs the relaxedposition-stretch movements using his hands or an electric treatment bed.To distribute the treatment dosage evenly to all points of the muscularand fascial group being treated, the treatment dosage is applied inseveral steps as described below:

First, the heads are placed covering all the origins and insertions ofthe whole muscular and fascial group being treated and then a firsttreatment step is applied. The duration of each treatment step variesbetween 1 min and 120 min depending on the program selected.

Once the first application step is finalized, the applicator's heads aredisplaced (between 0.5 cm and 15 cm depending on the muscle and type oftreatment) to cover a new untreated area of the myofascial unit and anew treatment step identical to the previous one is performed. Thisprocess is repeated by shifting the applicators after each treatmentstep until the whole area of the muscular and fascial group has receivedthe vacuum treatment. This is illustrated in FIG. 30.

The myofascial unit will progressively relax due to the effects of theapplied massage, the limitation of mobility will diminish and the rangeof mobility will increase.

After Phase 1 treatment has been applied a second phase (Phase 2) iscarried out. In Phase 2 a localized treatment is performed to treatpainful points, adhesions, adhesion in planes, tension, retractileprocesses, spasticity, oedema and haematoma local to the muscular and/orfascial group, which may still persist after the first stage (Phase 1)of treatment.

If either myofascial mobility and muscular tension assessments have beenassigned to Grade 1 a treatment comprising only Phase 2 (describedabove) is carried out.

In an embodiment of the present invention when performing treatmentphases 1 and/or 2 described above the device described in WO 2011/101388A1 is configured so that it exerts a pulsed suction through itsapplicators (110). It is particularly convenient to set the pattern ofvacuum pulses applied with the device as follows:

The TIME UP will be fixed at a value comprised between 0.01 and 3seconds; PULSE LENGTH will be fixed at a value comprised between 0.01and 15 seconds, the TIME DOWN will be fixed at a value comprised between0.01 and 2 seconds; and the MAXIMUM VACUUM value will be selected at avalue comprised between 20 and 200 mbars taking into consideration thesensitivity of the area to be treated and the patient's tolerance; andthe MINIMUM VACUUM value will be fixed at a value (in mbars) within therange of 0% to 30% of the MAXIMUM VACUUM value. The total length ofpulse (TIME UP+PULSE LENGTH+TIME DOWN) is normally ranging between 0.03and 20 seconds. The precise value will be established taking intoconsideration a number of factors such as the age and the physicalconstitution of the patient, and the tissue sensitivity of the area tobe treated.

When, as a result of the diagnostic, the practitioner has treated withvacuum one or more affected myofascial units in one side of the body itis possible that an unbalance is originated in the biomechanics of thepelvis, knee, vertebral column, craneo-cervical area, and/or scapulararea. In effect, the efficiency of the treatment in reducing tension andmaking the pathological myofascial unit more pliable at the side of thebody that, has been treated may result in that this side ends up havingmore mobility than its counterpart on the other side (which wasinitially the more healthy), leading to problems of biomechanicaladaptation at pelvic and vertebral level. For this reason, it isadvisable to repeat the treatment on the other side of the body so thatboth sides are equally treated thereby facilitating the biomechanicaladaptation. Nevetherless, it is not necessary to treat the myofascialunits at the contralateral side of the body with the same intensityapplied to the side of the body having the lesion. Consequently ratiobetween the number of vacuum treatment dosages applied to the affectedmyofascial unit(s) and the number of vacuum treatment dosages applied tothe counterpart myofascial unit (the healthy one) is higher than 1:1,preferably between 1:2 to 1:10, more preferably between 1:10 and 1:100.

Treatment of Articulations

In the case that the myofascial unit treated is an articulation thefollowing benefits may be obtained from the treatment:

-   -   1. Restoring range of joint motion.    -   2. Alleviating joint pain of any kind.    -   3. Ameliorating degenerative joint disease.    -   4. Draining intraarticular and periarticular oedema.    -   5. Decreasing articular coaptation.    -   6. Ameliorating spasticity or retractile process on a joint

Before starting the treatment of an articulation or joint it isadvisable for the practitioner to analyze the degree of flexibility orrestriction of the myofascial units that insert into that joint and ratethem using the rating system explained in the “Fascial and muscularsystem” section. If a myofascial restriction is found, it is necessaryto first treat the myofascial unit or units which have insertions in theaffected articulation because limited joint movement may be due totension present in the myofascial unit- or myofascial units—which insertinto the joint. In effect, the points of origin and insertion of themyofascial unit (via osteotendinous unions) are found in theperiarticular area, where they exert different motions on the joint(i.e. flexion or extension, rotation, abduction or adduction, sidebending). When a myofascial unit is in tension, and presents a limitedrange of flexibility, or has retractile condition, the myofascial unitwill limit the range of motion on that joint on which it has dominance.This increases joint pressure (through coaptation) and facilitatesinflammatory process and/or joint degeneration.

To sum up, to achieve maximum efficiency in localized treatment on ajoint, it is key to restore the flexibility in the different myofascialunits that control that joint. This is why the first step undertaken bythe practitioner in treating an affected joint (restricted or painful)will be to assess, and if needed, normalize fascial tension, using themyofascial system treatment method previously mentioned.

When treating articulations it is particularly convenient to set thepattern of vacuum pulses applied with the device as follows:

The TIME UP will be fixed at a value comprised between 0.01 and 0.6seconds; PULSE LENGTH will be fixed at a value comprised between 0.01and 2 seconds, the TIME DOWN will be fixed at a value comprised between0.1 and 2 seconds; and the MAXIMUM VACUUM value will be selected at avalue comprised between 40 and 130 mbars taking into consideration thesensitivity of the area to be treated and the patient's tolerance; andthe MINIMUM VACUUM value will be fixed at a value (in mbars) within therange of 0% to 45% of the MAXIMUM VACUUM value. The total length ofpulse (TIME UP+PULSE LENGTH+TIME DOWN) is normally ranging between 0.03and 4.6 seconds.

When undertaking treatment of an articulation the practitioner willchoose among different alternative treatment options depending on thesymptoms presented by the articulation as described below:

If articular oedema is the prevailing symptom, the practitioner shouldcarry out the venous return and lymphatic drainage treatment (describedlater in the venous return and lymphatic drainage system section).

If the prevailing symptoms are one or more of pain, limited range ofmotion or typical symptoms of degenerative processes a localizedtreatment is carried out on the articulation and its periphery. Thetreatment should start with the application of the vacuum stimulus tothe articulation held in a relaxed position.

After treatment of the articulation in the relaxed position, thepractitioner evaluates whether the range of motion of the articulationhas ameliorated. To do this the practitioner mobilizes the bone (orbones) or the joint under assessment, testing movements offlexo-extension, rotation, abduction and adduction, side bending etc.(depending of the bone and joint under assessment).

In the case that the previous treatment with the joint in the relaxedposition has not ameliorated the range of motion of the joint thepractitioner will change the status of the joint from the initialrelaxed position to a slightly stretched position and repeat thetreatment described above. Again at the end of the treatment thepractitioner evaluates whether there has been an amelioration and ifthis is not the case proceed to further increase the degree of stretchof the joint and repeat the treatment as many times as necessary.

This iterative procedure allows the application of the vacuum stimulusat different levels of stretch and achieves greater efficiency therebygenerating immediate beneficial effects such as an increase in range ofmotion/flexibility of the joint.

Treatment of Connective Tissue

In the case that the treatment is applied to the connective tissue astimulation of the tissue is achieved which results in an improvement ofthe retractile process (or non-elastic) of the connective tissue. Thisimprovement enables patients to recover movement in fascia, inaponeurosis and in articulations that had lost their elastic properties;manifesting in retractions in the connective tissue system, with limitedelasticity (whether due to age, training, overuse, repetitive movementsor previous injury), a loss that was considered normal and is commonlyconsidered irreversible.

The following treatment protocol is effective in recuperating theelasticity of the connective tissue system:

TIME UP is fixed at a value comprised between 0.2 and 0.3 seconds;

PULSE LENGTH is fixed at a value comprised between 0.5 and 0.6 seconds

TIME DOWN is fixed at a value comprised between 0.2 and 0.3 seconds

MAXIMUM VACUUM is fixed at a value comprised between 60 and 100 mbars.

MINIMUM VACUUM value is fixed at a value of 0 mbar.

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) is normallyranging between 0.9 and 1.2 seconds.

The total wave time is between 3 and 4 minutes and the total treatmenttime is between 3 and 4 minutes,

To be effective the treatment needs to be applied over the whole area ofthe connective tissue under treatment.

An example of this treatment in described in EXAMPLE 4.

Treatment of Venous System

As previously explained the treatment by applying a variable vacuumstimulus to the area in need of such treatment is particularly valuablewhen treating the lesion or lesions located along a tensional chain.

Nevertheless it is also possible to apply variable vacuum stimulus totreat problems of the venous system such as venous stenosis of anyorigin (muscular, connective tissue system, post-surgery fibrosis),venous insufficiency (and pain associated to it), dilated veins(varicose, spider/broken veins), insufficiency or dysfunction of venousvalves and oedema or fluid retention due to insufficiency. When treatingproblems of the venous system the practitioner will proceed in twoseparate stages: a first step to reduce venous stenosis and a secondstep to drain fluids. Two of the most notable problems of the venoussystems that may be treated are venous stenosis and problems of venousdrainage as described below:

Venous Stenosis.

It has been found that the existence of myofascial or connective tissueunder tension is often an underlying cause of venous stenosis therebyreducing the efficiency of drainage, creating venous insufficiencyand/or reducing the functioning of the local valves. It has also beenfound that certain areas of dense miofascial and connective tissue areparticularly prone to cause stenosis on local veins when being undulytensioned. These areas are the following:

a) Internal and posterior region of the knee; great saphenous vein,minor saphenous vein, popliteal vein.

b) Scarpa's triangle and saphenous hiatus; femoral vein, great saphenousvein, circumflex iliac vein, superficial epigastric vein, superficialexternal pudendal vein, accessory saphenous vein.

c) Anterior, lateral and internal region of the ankle; the veins in thefoot.

d) Muscle and fascia of the adductor major, adductor longus, sartorious,vastus medialis, hiatus of the adductor major, anteromedialintermuscular septum; femoral vein.

e) Subclavicular space; Subclavicular and cephalic vein.

f) Axillary region and anterior part of the shoulder; axillary andcephalic vein.

g) Anterior region of the elbow; cephalic and basilic vein.

h) Anterior and posterior region of the carpal bone; veins in the hand.

i) Region comprising the masseter muscle and fascia, inferior region ofthe ear, muscle and fascia of the sternocleidomastoid and platysmamuscle; internal, external and anterior jugular vein, fascial veins,superficial temporal veins, posterior auricularis veins,retromandibular, angular, supraorbitary and infraorbitary veins.

Thus, when a patient presents a dysfunction in the venous system, thepractitioner will carry out a treatment on the areas of dense connectiveand myofascial tissue to reduce the venous stenosis using the variablevacuum stimulus as described above for the treatment of the myofascialsystem. It has been found that the application of the variable vacuumstimulus successfully reduces stenosis of the veins in the treatedregion. As a result, venous return, oedema, inflammation and valvefunction is also improved.

When treating venous stenosis it is particularly convenient to set thepattern of vacuum pulses applied with the device as follows:

The TIME UP will be fixed at a value comprised between 0.01 and 3seconds; PULSE LENGTH will be fixed at a value comprised between 0.01and 15 seconds, the TIME DOWN will be fixed at a value comprised between0.01 and 2 seconds; and the MAXIMUM VACUUM value will be selected at avalue comprised between 20 and 200 mbars taking into consideration thesensitivity of the area to be treated and the patient's tolerance; andthe MINIMUM VACUUM value will be fixed at a value (in mbars) within therange of 0% to 30% of the MAXIMUM VACUUM value. The total length ofpulse (TIME UP+PULSE LENGTH+TIME DOWN) is normally ranging between 0.03and 20 seconds.Venous Drainage

The treatment is performed by applying at the region of the vein that ismore distal with respect to the associated area of dense connectivetissue a vacuum stimulus consisting of 1-8 pulses with a total wave timebetween 0.3 and 1.4 seconds each pulse. Then, the applicator isdisplaced stepwise between 0.5 and 10 cm in the direction of the centreof the dense connective tissue and a vacuum stimulus consisting of 1-8pulses is applied after each displacement until the central point of thedense connective tissue is reached. The whole process may be repeated upto a maximum of 10 times for a total treatment time of 15 to 70 minutesdepending on the number veins to be treated.

When treating venous stenosis it is particularly convenient to set thepattern of vacuum pulses applied with the device as follows:

The TIME UP will be fixed at a value comprised between 0.01 and 0.6seconds; PULSE LENGTH will be fixed at a value comprised between 0.01and 0.5 seconds, the TIME DOWN will be fixed at a value comprisedbetween 0.1 and 0.6 seconds; and the MAXIMUM VACUUM value will beselected at a value comprised between 20 and 100 mbars taking intoconsideration the sensitivity of the area to be treated and thepatient's tolerance; and the MINIMUM VACUUM value will be fixed at avalue (in mbars) within the range of 0% to 10% of the MAXIMUM VACUUMvalue. The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) isnormally ranging between 0.12 and 1.7 seconds.Treatment of Lymphatic System

It is also possible to apply variable vacuum stimulus to treat problemsof the lymphatic system such as lymphatic insufficiency, primary orsecondary lymphoedema and pain caused by lymphatic fluid retention.

It has been observed that post-surgical fibrotic scar tissue and/ortension in the connective and myofascial system may cause an obstructionin the lymphatic system (stenosis on the lymphatic ducts and/orlymphatic nodes thereby causing oedema, inflammation and/or swelling

When treating problems of the lymphatic system the practitioner willproceed in two separate stages: a first step consisting in the treatmentof groups of lymph nodes to reduce stenosis therein and a second step todrain fluids from the symptomatic lymphatic ducts.

Treating Groups of Lymph Nodes

Thus, when a patient presents a dysfunction in the lymph system, thepractitioner will carry out a treatment on the groups of lymph nodes toreduce the stenosis using the variable vacuum stimulus as describedabove for the treatment of the myofascial system. It has been found thatthe application of the variable vacuum stimulus successfully reducesstenosis of the lymph nodes in the treated region. As a result thenormal function of the lymphatic ducts is restored allowing a correctdrainage.

When treating groups of lymph nodes it is particularly convenient to setthe pattern of vacuum pulses applied with the device as follows:

The TIME UP will be fixed at a value comprised between 0.01 and 3seconds; PULSE LENGTH will be fixed at a value comprised between 0.01and 15 seconds, the TIME DOWN will be fixed at a value comprised between0.01 and 2 seconds; and the MAXIMUM VACUUM value will be selected at avalue comprised between 20 and 200 mbars taking into consideration thesensitivity of the area to be treated and the patient's tolerance; andthe MINIMUM VACUUM value will be fixed at a value (in mbars) within therange of 0% to 30% of the MAXIMUM VACUUM value. The total length ofpulse (TIME UP+PULSE LENGTH+TIME DOWN) is normally ranging between 0.03and 20 seconds.Lymphatic Ducts Drainage

The treatment is performed by applying at the region of the lymph ductthat is more distal with respect to the associated group of lymph nodes,a vacuum stimulus consisting of 1-8 pulses. Then the applicator isdisplaced stepwise between 0.5 and 10 cm in the direction of the centreof the dense connective tissue and a vacuum stimulus consisting of 1-8pulses is applied after each displacement until the central point of thedense connective tissue is reached. The whole process may be repeated upto a maximum of 10 times for a total treatment time of 15 to 70 minutes.

When performing drainage of the lymphatic ducts it is particularlyconvenient to set the pattern of vacuum pulses applied with the deviceas follows:

The TIME UP will be fixed at a value comprised between 0.01 and 0.6seconds; PULSE LENGTH will be fixed at a value comprised between 0.01and 0.5 seconds, the TIME DOWN will be fixed at a value comprisedbetween 0.1 and 0.6 seconds; and the MAXIMUM VACUUM value will beselected at a value comprised between 20 and 110 mbars taking intoconsideration the sensitivity of the area to be treated and thepatient's tolerance; and the MINIMUM VACUUM value will be fixed at avalue (in mbars) within the range of 0% to 10% of the MAXIMUM VACUUMvalue. The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) isnormally ranging between 0.12 and 1.4 seconds.Treatment of Microcirculation

Finally it has been found that it is also possible to apply variablevacuum stimulus to activate microcirculation of fluids in theextracellular space and in the blood vessels. The activation ofmicrocirculation is associated with a number of beneficial effects suchas the activation of the transport of oxygen, CO₂, nutrients (glucose,sodium, potassium, vitamins . . . ), electrolytes in the extracellularspace, the improvement of cellular interchange, the improvement ofcellular metabolism, the increase of the electrical potential of themembrane, the improvement of cell and tissue regeneration and thedrainage of extracellular toxic metabolic waste.

When treating microcirculation it is particularly convenient to set thepattern of vacuum pulses applied with the device as follows:

The TIME UP will be fixed at a value comprised between 0.01 and 0.3seconds; PULSE LENGTH will be fixed at a value comprised between 0.01and 0.5 seconds, the TIME DOWN will be fixed at a value comprisedbetween 0.1 and 0.6 seconds; and the MAXIMUM VACUUM value will beselected at a value comprised between 50 and 140 mbars taking intoconsideration the sensitivity of the area to be treated and thepatient's tolerance. The total length of pulse (TIME UP+PULSELENGTH+TIME DOWN) is normally ranging between 0.12 and 1.4 seconds.

The treatment is performed by applying to the area in which it isdesired to activate microcirculation a variable vacuum stimulus as shownin FIG. 14. During PULSE LENGTH the suction stretches, compacts andsqueezes the tissue that is receiving the force of the suction throughthe applicator, the pressure on the tissue is transmitted to theextracellular space and local vessels, generating a mobilization ofextracellular liquid and microcirculation in the vessels. During theRELAXATION TIME the vacuum is reduced to a value close to zero or in thealternative a negative vacuum (positive pressure) up to 40 mbars isapplied and the microcirculation moves once again through osmosis. Thus,the variable vacuum stimulus generates a pump effect on theextracellular space and microcirculation, the stimulus is similar to theaction of an active muscle; a combination of contraction (PULSE LENGTH)and relaxation (RELAXATION TIME). The pulse (contraction-relaxation) hasto be quick (the quicker the pulse rate, the more stimulated themicrocirculation). If it is pain free for the patient a pulse rate ofmore than one stimulus per second is preferably used.

The present diagnostic and treatment method has been found useful forthe diagnosis and treatment of conditions related to the skeletal musclesystem, such as acute muscle tension (contraction), chronic muscletension (contraction), muscle pain, muscle fibrosis, muscle atrophy;conditions related to the fascia system, such as acute and chronicfascia tension, acute and chronic retractile processes, myo- andinterfascial adhesions, myo- and interfascial oedema, fibrosis of thefascial system, compartment syndrome, nerve hiatus stenosis, venoushiatus stenosis, arterial hiatus stenosis, lymphatic vessel hiatusstenosis, capsulitis; conditions related to the vascular system, such asvenous stenosis, arterial stenosis, ischemia, hypoxia, varicose veins,cellulite, oedema; conditions related to the lymphatic system, such asstenosis of the lymphatic node and vessels system, lymphatic retention,lymphoedema; conditions related to the joint system, such as lumbago,backache, neck pain, pelvic and sacroiliac joint pain, coxalgia,coxofemoral joint pain, patellofemoral pain, knee joint pain, foot pain,scapular pain, glenohumeral pain, acromioclavicular pain,clavico-sternal pain, costocondral pain, costosternal pain,sternoxiphoid joint pain, costotransverse joint pain, atlanto-occipitaljoint pain, elbow pain, carpal pain, hand pain, hand pain, cranialsuture pain, temporomandibular pain, tendon pathology (tendinitis,tendosynovitis, etc.), flexor retinaculum pathology (carpal tunnelsyndrome, etc.), synovial pathology, ligament pathology, limiting ofjoint movements, increase in articular coaptation, intra andperi-articular oedema, degenerative joint pathology, arthropathy;conditions related to the nervous system, such as neuropathic pain,hyperaesthesia, hypoaesthesia, nerve stenosis, peridural stenosis,perinerve stenosis, nerve stenosis caused by articular pressure, nervestenosis caused by muscle tension, nerve stenosis caused by fasciasystem pressure, nerve degeneration, post-surgical fibrosis, ischemia,hypoxia, perinerve, endonerve and epinerve oedema, perinerve fibrosisand other miscellaneous conditions such as fibromyalgia, carpal tunnelsyndrome, post-surgical fibrosis, urinary and faecal incontinence,benign prostatic hypertrophy, impotence, anorgasmia, dyspareunia, dryvagina, myofibromas, uterine polyps, endometriosis, constipation,flatulence, inhibition of intestinal peristaltism, intestinalcolic-pain, asthma, acute and chronic bronchitis, chronic pharyngitis,eyestrain, cervical tinnitus, vertigo, capsular contracture caused bybreast implants, fibrosis caused by burns and whiplash injury.

Treatment of Fibrosis and/or Adhesions

The description below contains the details for the treatment of fibrosisand adhesions such as post-surgery fibrosis, fibrotic tissue causedthrough scar formation, post fibre rupture reconstruction and/orinfection and the presence of adhesion between tissue planes.

The following effective and pain free treatment of fibrosis andadhesions seeks to give a bio-stimulus to the fibrosis in order togenerate a change in the elasticity of the fibrotic tissue, to restorerange of movement, restore tissue elasticity, reduce neurovascularstenosis, reduce pain and increase vascularization in the area.

Fibrosis responds well to treatment with the application of acombination of two kinds of stimulus:

1. Short pulse stimulus (short total length of pulse)

2. Long pulse stimulus (long total length of pulse), preferably combinedwith localized maneuvers carried out by the practitioner).

The treatment begins with the application of short pulse stimulusprogram followed by a long pulse stimulus program with maneuvers. Adescription of the two treatments follows:

Short Pulse Stimulus (Short Total Length of Pulse)

The treatment enables the application of a massage action using a vacuumstimulus consisting of relatively short pulses having a total length ofpulse between 0.5 and 2 seconds and a MAXIMUM VACUUM between 20 and 150mbars (the intensity of the vacuum will be selected depending on thesensitivity of the fiber). The total wave time on a given fibrotic areais comprised between 1 and 7 minutes.

The best efficacy in fibrosis treatment appears when applying vacuumusing the following parameters:

TIME UP is fixed at a value comprised between 0.2 and 0.3 seconds;

PULSE LENGTH is fixed at a value comprised between 0.4 and 0.5 seconds

TIME DOWN is fixed at a value comprised between 0.2 and 0.3 seconds

MAXIMUM VACUUM is fixed at a value comprised between 30 and 100 mbarstaking into consideration the sensitivity of the area to be treated andthe patient's tolerance: Initially it is set at 100 mbars. If thepatient does not report any painful sensation the treatment is continuedat this value. If the patient reports pain during the treatment theMAXIMUM VACUUM is reduced in steps of 10 mbars until no pain isreported. No pain has ever been reported at MAXIMUM VACUUM LEVELS of 30mbars.MINIMUM VACUUM value is fixed at a value (in mbars) within the range of0% to 30% of the MAXIMUM VACUUM value.

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) is normallyranging between 0.8 and 1.1 seconds.

The stimulus generated on the fibrotic tissue by the treatment improvesflexibility and colour and reduces hardness, thickness, pain andinflammation of this tissue and generates a recovery of the orientationof the collagen fibrils involved in the remodeling and improvement ofthe scar tissue fibrosis. This effect is also seen in the deep layers(at periosteum level).

Detailed Treatment Procedure

The applicators are placed on the scar and the vacuum stimulus isapplied (total wave time). Once the stimulus is over, the applicatorsare moved (0.1-2 cm) along from the fulcrum point following thetrajectory of the scar. The more apparent the fibrosis, the smaller thedistance moved. The applicators are shifted after each wave of pulses,until treatment has been administered on the whole area of the scar.

The treatment on the scar can be applied between 1-8 times, as needed.

The size of the head used in the first treatment step is important asthere should be no pain caused during the treatment; small heads(between 1 and 42 cm²) are used for this. Once the first treatments havebeen administered and no pain has been reported by the patient,applicators of a larger size may be used (between 1 and 110 cm²).

The periphery of the scar/fibrosis also needs to be treated; this can bedone either before or after the treatment on the scar. The same stimulusand procedure is used as for the treatment of the scar.

An example of this treatment in described in EXAMPLE 3.

Effects:

The purpose of the suction massage stimulus is to generate a combinationof stretch-relaxation on the fibrotic fiber. Numerous stimuli aregenerated per minute (between 130 and 30 stimuli per minute) because thetime between these stimuli is short. The different effects are:

1. A positive bio-stimulus on the fibrosis, allowing the fibrosis tobecome more pliable; it becomes more elastic and thus reduces thecapacity of stenosis (a key feature of this process)

2. The stretch stimulus on the planes and the massage on theadhesions/fibrosis may generate detachment or rupture of the adhesionsand/or fibrosis.

3. Stimulus to the fibroblast can stimulate the production of elastin,generating a progressive change of fibrotic fibre toward pliable fibre.

4. The use of short trapezium time with a high number of pulsations perminute (between 120 and 30 stimuli per minute) has a major stimulatoryeffect on the vascular and lymphatic system draining localized oedemaand increasing vascularisation. Pain relief is swift and recovery isquicker and more effective.Long Pulse Stimulus (Long Total Length of Pulse)

The second treatment step involves the application of long pulsestimulus having a total length of pulse between 2.1 and 15 seconds.During the duration of each pulse the practitioner can execute stretchmaneuvers on the fibrosis (in the same way described in the section“Localized treatment with maoeuvers”) of the myofascial system.

As described there; during each pulse the practitioner can stretch thefibrosis and mobilize the planes under the scar in 8 directions todecide which direction/s present limitations (because ofadhesion/fibrosis). Once the restriction is localized, the practitionerexecutes the maneuver treatment.

The best efficacy in treatment for releasing any adhesion/fibrosisbetween any affected plane (fascia, aponeurosis, myofascial, perineural,bone, tendon, ligament, nerve etc.) is achieved using vacuum stimulidefined through the following parameters:

TIME UP is fixed at a value comprised between 0.2 and 1 second;

PULSE LENGTH is fixed at a value comprised between 5 and 15 seconds

TIME DOWN is fixed at a value comprised between 0.2 and 1 second

MAXIMUM VACUUM is fixed at a value comprised between 60 and 140 mbar.

MINIMUM VACUUM value is fixed at 0 mbar.

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) is normallyranging between 5.4 and 17 seconds.

While the vacuum stimulus is at its maximum value maximum suction isexerted on the tissue thereby stretching the underlying planes. It isduring this time that the practitioner maneuvers the applicator head andthus stretches the tissue planes further. These maneuvers help mobilizethe adhered planes in order to release the adhesions present between thedifferent planes.

Treatment frequency and treatment duration: 1 to 5 treatments per weekcan be applied. When only one treatment a week is applied the durationof the treatment time is longer; between 40 and 75 minutes. If there are2-5 treatments a week treatment time per treatment is lower; between 15and 35 minutes.

An example of this treatment in described in EXAMPLE 5.

Action

The above described treatment generates a bio-stimulus on the fibroticarea that helps detaching or breaking the fibers present between the twotissue planes. These effects help recover the movement between thetissue planes, make the scar tissue more flexible and reduce thestenosis that the fibrosis has produced in the other tissues.

While the second step of the treatment (application of long pulsestimuli) has lesser effect on the vascular and lymphatic system comparedto the treatment with the short trapezium time, it has a greater effecton gaining elasticity in the fibrosis and detaching adhesions betweenlarger planes

EXAMPLES Example 1: How to Identify and Interpret the Injury ChainArising in the Right Ischiotibial Muscle

A patient has been suffering from lumbar pain in vertebral joints L3, 4,5 and in the right and left paravertebral muscles for the past 2 years.The practitioner observes a right posterior injury chain in the rightparavertebral muscle; the injury chain continues along the right gluteusmaximus and continues to the right ischiotibial muscle. The next linksin the chain are the calves, but they are not suffering from tension.Therefore the link in the most caudal position (the lowest one) is theright ischiotibial muscle: this is what causes the injury chain (it isthe one that constitutes the “primary lesion” or “site of origin” in theinjury chain. Consequently if the right ischiotibial muscle is notreleased, the kinetic chain on the lumbar region will not disappear.

According to the Saló-Darder method, the interpretation is that thepatient has an injury chain which starts in the right ischiotibialmuscle and causes an injury chain in two regions: in the bone area andin the part of the connective joint of the fascia to the gluteusmaximus. Let's take a detailed look at each of these regions.

With respect to the bone area, it should be remembered that theischiotibial muscle is inserted into the knee joint and the iliac bone(ischium); when the ischiotibibial muscle is in tension it pulls theiliac bone, favouring iliac retroversion. The latter movement generatesan incorrect movement of the sacrum, causing an imbalance at the basethat supports the spine. In turn, the movement of the iliac boneproduces compensatory tension in the muscles of the lumbar region andiliac crest (paravertebral muscles and lumbar quadrate muscles).

With regard to the fascia system, it should be borne in mind that theischiotibial and gluteus maximus muscle fascia have a union (the hingejoint) where the movement is made jointly by both of them, entwined in amyofascial chain. The ischiotibial tension thus produces tension on thefascia and the gluteus maximus muscle, which, due to being inserted intothe sacrum and posterior iliac crest, exercises an unstable kineticchain on the biomechanics of the sacrum and pelvis and the antagonistmuscles and fascia system of the tension exerted by the gluteus maximumand its fascia are in tension, in order to rebalance the pelvic-lumbarmechanical tension. The result is an imbalance in the spinal column.

This situation leads to constant tension (chronic) on the lumbar region,which is the reason why local treatment on the lumbar region has noeffect. Thus, once the practitioner has relieved the tension in theright ischiotibial and right gluteus maximus, the injury chain willdisappear and the tension balance on the pelvis, sacrum and spine willbe restored. When the injury chain has been eliminated, the practitionercan apply local treatment to the painful lumbar region, which is muchmore effective.

Example 2: Application of the Treatment Method to Patients Sufferingfrom Chronic Neck Pain

A study was conducted in which the Fisium device was used on 20 patientswith chronic neck pain.

The state of the patient before and after treatment was evaluated usingtwo groups of parameters:

-   -   1. Movement parameters (flexion and extension as illustrated in        FIG. 1; tilting of head to the right and left as illustrated in        FIG. 2 and right and left rotation as illustrated in FIG. 3).    -   2. Pain level measured in accordance with the VAS (Visual        Analogue Scale).

The treatment was effected by applying negative pressure (vacuum usingthe device shown in FIGS. 11 and 12, which correspond to FIGS. 6 and 7of WO 2011/101388, which is hereby incorporated by reference herein inits entirety. In FIGS. 11 and 7 an embodiment of a skin treatmentassembly 200 is shown. The treatment assembly 200 comprises a suctionmachine 100 and a support device 10.

The suction machine 100 comprises a housing 150 provided with wheels 155at the base thereof for ease of moving. Control means 160 are alsoprovided for controlling certain treatment parameters such as length,pressure, applicator position, etc. Control means 160 include outputmeans comprising a display screen 161 through which the practitioner isallowed to control treatment. A keyboard can be provided for enteringtreatment parameters and selecting a mode of treatment. The displayscreen 161 is fitted at one end of a mount arm 162. The mount arm 162 isattached, at the opposite end thereof, to the suction machine housing150. There may be embodiments in which the control means 160 are fittedin the support device 10 instead of the suction machine 100 such that itis nearer to the practitioner.

Suction means 120 are provided within the housing 150 of the suctionmachine 100. Suction means 120 may comprise a vacuum pump suitable forapplying different pressurized airflow patterns (for example, pressurechanging values every 0.1-0.5 s) to a patient through applicators 110.

The support device 10 comprises a connecting member 30 that isdisplaceably mounted on a support member 11. Base portion 12 is formedof a series of supporting arms 13 each carrying a dual wheel carpetcaster 14. The wheeled base portion 12 allows the support device 10 tobe easily moved in the proximity of a patient's body for a suitablepositioning for a skin treatment. Alternatively, the base portion can befixed. The support device 10 further comprises an arm structure 20. Thearm structure 20 of the support device 10 is pivotally coupled to theconnecting member 30 through a substantially horizontal first axis.Rotation of the arm structure 20 to the connecting member 30 anddisplacement (upwards/downwards) of the connecting member 30 along thesupport member 11 allows the relative vertical position of the armstructure 20 to be accurately adjusted. Said relative vertical positionis defined as the height of applicators 110 to the ground.

The carrying structure 40 of the arm structure 20 further comprises acarrying bar 45 that can be adapted for receiving a corresponding hoseconnector 50, 60. Each hose connector 50, 60 is provided with one inlet70 and one outlet 80. The inlet 70 is provided with a movable joint 71that is adapted for receiving at least one negatively pressurized airinlet hose 90 that conducts negatively pressurized air from a suctionmachine 100 to the support device 10. The outlet 80 of the hoseconnectors 50, 60 may be also provided with a corresponding movablejoint 81 adapted for receiving at least one pressurized air outlet hose96, 97. Said outlet hoses 96, 97 lead to respective applicators 110.With this arrangement, several modes of treatment can be used, forexample including either the supply of the same pressure values throughall the outlet hoses 96, 97 or the supply of different negative pressurevalues through said outlet hoses 96, 97 according to the treatmentrequirements.

The treatment of patients was effect by applying a variable pattern ofnegative pressure defined through the following parameters: TIME UP=0.2seconds; PULSE LENGTH=0.5 seconds; TIME DOWN=0.3 seconds; RELAXATIONTIME=0.1 seconds; MINIMUM VACUUM=0 mbars; MAXIMUM VACUUM=100 mbars (forpatients whose age is comprised between 14- and 50 years), 90 mbars (forpatients whose age is comprised between 51 and 60 year old) and 80 mbars(for patients older than 60 year old).

The treatment consists is performed in 5 phases:

1. The right and left posterior tensional chains are relaxed placing theheads along posterior pelvic, lumbar and thoracic zones. 8 zones aretreated simultaneously with the adjustable fixed arms; 4 treatmentseries of 3 minutes each (12 minutes in total) are applied; after eachtreatment, the heads are shifted to apply dosage on untreated zones. Theposition of the applicators (110) during treatment is illustrated inFIGS. 21 and 22.

2 Localized treatment to scapular muscles (suprapinal, trapezius andrhomboids, Levatator scapulae; etc.) using mobile arms. These musclesbelong to the RPTC or LPTC (depending on the side), and transversescapular potential tensional (TSTC) chains. After 4 or 6 pulses, thetherapist shifts the applicators (110) 3 cms along the treatment zone.Treatment total time: 14 minutes. The position of the applicators (110)during treatment is illustrated in FIGS. 23 and 24.

3. The therapist proceeds to treat cervical muscles (belonging to RPTCand LPTC). After 4 or 6 pulses, the therapist shifts the applicators(110) 3 cms along the treatment zone. Treatment total time: 7 minutes.The position of the applicators (110) during treatment is illustrated inFIGS. 25 and 26.

4. The therapist proceeds to treat the cervical anterior and lateralmyofascial units belonging to both medial (RMTC and LMTC) and lateral(RLTC and LLTC) tensional chains. After 4 or 6 pulses, the therapistshifts the applicators (110) 3 cms along the treatment zone. Treatmenttotal time: 8 minutes. The position of the applicators (110) duringtreatment is illustrated in FIG. 27.

5. The therapist assesses the range of mobility and performs localizedtreatment to treat painful points, adhesions, adhesion in planes,tension, retractile processes, spasticity, oedema and haematoma local tothe muscular and/or fascial group. After 4 or 6 pulses, the therapistshifts the applicators 3 cms along the treatment zone. Treatment totaltime: 8 minutes. The position of the applicators (110) during treatmentis illustrated in FIG. 28.

The results of the study are summarised in the following charts andgraphs:

FIG. 1: Flexion and extension of the head.

FIG. 2: Tilting of head to the right and left.

FIG. 3: Right and left rotation of the head.

FIG. 4: Improvement in the degree of flexion achieved by patients.

Patients were classified in three groups according to their capacity toflex the head:

-   -   Group 1: Patients who were unable to flex the head more than 40°    -   Group 2: Patients who were able to flex the head between more        than 41° and 59°    -   Group 3: Patients who were able to flex the head at least 60°        (considered healthy)

The figure shows the percentage of patients in each group beforestarting treatment and after 1, 2, 3 and 4 treating sessions. It may beseen that from the third session all patients treated could beconsidered healthy.

FIG. 5: Improvement in the degree of extension achieved by patients.

Patients were classified in three groups according to their capacity toextend the head:

-   -   Group 1: Patients who were unable to extend the head more than        35°    -   Group 2: Patients who were able to extend the head between more        than 36° and 49°    -   Group 3: Patients who were able to extend the head at least 50°        (considered healthy)

The figure shows the percentage of patients in each group beforestarting treatment and after 1, 2, 3 and 4 treating sessions. It may beseen that from the third session practically all patients treated couldbe considered healthy.

FIG. 6: Improvement in the degree of tilting to the right achieved bypatients.

Patients were classified in three groups according to their capacity totilt the head to the right:

-   -   Group 1: Patients who were unable to tilt the head to the right        more than 20°    -   Group 2: Patients who were able to tilt the head to the right        between more than 21° and 39°    -   Group 3: Patients who were able to tilt the head to the right at        least 40° (considered healthy)

The figure shows the percentage of patients in each group beforestarting treatment and after 1, 2, 3 and 4 treating sessions. It may beseen that from the third session practically all patients treated couldbe considered healthy.

FIG. 7: Improvement in the degree of tilting to the left achieved bypatients.

Patients were classified in three groups according to their capacity totilt the head to the left:

-   -   Group 1: Patients who were unable to tilt the head to the left        more than 20°    -   Group 2: Patients who were able to tilt the head to the left        between more than 21° and 39°    -   Group 3: Patients who were able to tilt the head to the left at        least 40° (considered healthy)

The figure shows the percentage of patients in each group beforestarting treatment and after 1, 2, 3 and 4 treating sessions. It may beseen that from the third session practically all patients treated couldbe considered healthy.

FIG. 8: Improvement in the degree of rotation to the right achieved bypatients.

Patients were classified in three groups according to their capacity torotate the head to the right:

-   -   Group 1: Patients who were unable to rotate the head to the        right more than 35°    -   Group 2: Patients who were able to rotate the head to the right        between more than 36° and 69°    -   Group 3: Patients who were able to rotate the head to the right        at least 70° (considered healthy)

The figure shows the percentage of patients in each group beforestarting treatment and after 1, 2, 3 and 4 treating sessions. It may beseen that from the fourth session practically patients treated could beconsidered healthy.

FIG. 9: Improvement in the degree of rotation to the left achieved bypatients.

Patients were classified in three groups according to their capacity torotate the head to the left:

-   -   Group 1: Patients who were unable to rotate the head to the left        more than 35°    -   Group 2: Patients who were able to rotate the head to the left        between more than 36° and 69°    -   Group 3: Patients who were able to rotate the head to the left        at least 70° (considered healthy)

The figure shows the percentage of patients in each group beforestarting treatment and after 1, 2, 3 and 4 treating sessions. It may beseen that from the fourth session practically patients treated could beconsidered healthy.

FIG. 10: VAS Score during treatment

FIG. 10 illustrates the distribution of patients according to their VASscore (Visual Analogue Scale) at the first visit/treating session, thesecond visit/treating session, the third visit/treating session and theforth visit/treating session.

The VAS score or Visual Analogue Scale is a score commonly used toevaluate the intensity of pain suffered by patients.

To determine the VAS Score the patient is shown a scale from 0 to 10(such as the one illustrated in FIG. 29) wherein a score of 0 indicatesno pain, scores of 1 to 3 indicate a mild pain (nagging, annoying,interfering little with activities of daily living), scores of 4 to 6indicate moderate pain (interferes significantly with activities ofdaily living) and scores of 7 to 10 indicate severe pain (disabling;unable to perform activities of daily living) and is asked to indicatethe number that would best describe his level of pain. This number isthe VAS Score for the patient.

It is observed that from the third visit, pain reduction among patientswas quite significant. From the fourth visit, the pain disappearedcompletely in all the patients.

Example 3: This Example Shows a Successful Treatment of a PatientReporting Pain in a Scar Produced by a Surgical Intervention

Medical history: A 60 year old patient, operated on an inguinal herniaon the left side, 12 months previously. Patient reports pain in the zoneof a scar produced by a surgical intervention. The scar is painful uponpalpation and the pain (VAS 8) was associated with a worsening of themovement and stretching evaluation.

Assessment:

a) Displacement of superficial fascia; there is NO movement in thesuperficial fascias (presence of adhesions).

Description of treatment: Since the underlying cause of the muscletension and the limitation in myofascial mobility is the existence ofpost-surgical fibrosis a treatment of fibrosis and adhesions was appliedas follows:

A 40 minutes session treatment has been applied once a week. After threesessions pain had disappeared:

Session 1:

a) Application of Short Pulse Vacuum Stimuli with the FollowingParameters:

TIME UP was fixed at 0.2 seconds;

PULSE LENGTH was fixed at 0.4 seconds

TIME DOWN was fixed at 0.3 seconds

MAXIMUM VACUUM was fixed at a value of 60 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 0.9seconds.

The total wave time at each position of the applicator heads was 1.50min.

Two 17 cm² applicators were placed on the scar, one where the scar beganand the other one in the center of the scar. The vacuum stimulusdescribed above was applied during 1 minute and 30 seconds. Throughoutthe duration of the treatment the applicators were not moved from thearea. Once the total wave time had ended the applicators were moved 1 cmalong the line of the scar and the vacuum stimulus was applied again (1min 30 sec). This was repeated until the whole of the scar had beentreated (the applicator which was at the beginning of the scar ended upin the middle and the applicator which began in the middle of the scarwill have been moved to the end of the scar. To cover the whole area ofthe scar 5 series of vacuum stimuli need to be administered (totaltreatment time 7.5 minutes).

Next, the applicators were changed to ones of a larger diameter (42cm²). One applicator was placed at the beginning of the scar and theother one at the center of the scar. The vacuum stimulus was applied fora total wave time of 1 minute and 30 seconds. Throughout the duration ofthe treatment the applicators were not moved from the area. Once thetotal wave time had ended the applicators were moved 1 cm along the lineof the scar and the vacuum stimulus was applied again. (1 min 30 sec).This was repeated until the whole of the scar had been treated (theapplicator which was at the beginning of the scar ended up in the middleand the applicator which began in the middle of the scar will have beenmoved to the end of the scar. To cover the whole area of the scar 5treatments needed to be administered (total treatment time 7.5 minutes).

After the above treatment the fibrosis improved and the scar became lessrigid and less sensitive to touch.

b) Application of Long Pulse Stimuli with the Following Parameters.

TIME UP was fixed at 1 second;

PULSE LENGTH was fixed at 8 seconds

TIME DOWN was fixed at 1 second

MAXIMUM VACUUM was fixed at a value of 70 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 10seconds.

The total wave time was 10 seconds (the wave consisted of a singlepulse).

The total treatment time at each position of the applicator heads was 15min.

A 42 cm² applicator was used. The applicator was placed at the beginningof the scar; the practitioner maneuvered the applicator and the tissuebeing treated in a northward direction during the “pulse length” (8seconds). The objective of the maneuver was to stretch the differentplanes of the tissues that had post surgery fibrosis and adhesions.During “time down”, the practitioner moved the applicator 1 cm along thescar and repeated this process until the whole length of the scar hadbeen covered. Once all the northward maneuvers were completed, thepractitioner repeated the process in a southward direction, then in aneastward direction and finally in a westward direction. It took 10minutes to complete all the maneuvers.

Once the maneuvers on the fibrosis were completed the practitionerassessed the movement or non-movement of the fibrotic tissue. To dothis, the practitioner displaced the tissue under the applicator in 8directions (north, northeast, east, southeast, south, southwest, westand northwest) during the “pulse length” cycle. This was made todetermine whether or not the tissue moved correctly or presentedlimitation when moved. The patient presented a limitation in thewestward direction. Having determined that the limitation was in thewestward direction, maneuvers were carried out to release the adhesionsto regain normal movement. During “Pulse length” (8 seconds) thepractitioner maneuvered the applicator in a westward direction tostretch the fibres present in these planes, when the “Pulse length”finished and during “Time down” the practitioner moved the applicator 1cm and repeated the maneuver until the treatment had covered the entirearea of the affected tissue under treatment. On termination of thepreceding treatment it was found that the maneuvers had beeninsufficient to change the fibrotic tissue and so the treatment wasrepeated. However, after the second treatment of maneuvers on thefibrosis there was a notable improvement in the tissue with over 50%increased mobility in the hypodermis and underlying planes. A treatmenttime of 5 minutes was needed.

Session 2:

a) Application of Short Pulse Vacuum Stimuli with the FollowingParameters:

The treatment was the same as in session 1, except for an increase of 10mbar in the MAXIMUM VACUUM which was possible because the patient's scarwas less painful after session 1:

TIME UP was fixed at 0.2 seconds;

PULSE LENGTH was fixed at 0.4 seconds

TIME DOWN was fixed at 0.3 seconds

MAXIMUM VACUUM was fixed at a value of 70 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 0.9seconds.

The total wave time at each position of the applicator heads was 1.50min.

The total treatment time was 27 min.

b) Application of Long Pulse Stimuli with the Following Parameters.

The treatment was the same as in session 1, except for an increase of 10mbar in the MAXIMUM VACUUM which was possible because the patient's scarwas less painful after session 1

TIME UP was fixed at 1 second;

PULSE LENGTH was fixed at 8 seconds

TIME DOWN was fixed at 1 second

MAXIMUM VACUUM was fixed at a value of 80 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 10seconds. The total wave time was 10 seconds (the wave was constituted bya single pulse).

The total treatment time was 13 min.

Session 3:

a) Application of Short Pulse Vacuum Stimuli with the FollowingParameters:

The treatment was the same as in session 2, except for an increase of 10mbar in the MAXIMUM VACUUM which was possible because the patient's scarwas less painful after session 2:

TIME UP was fixed at 0.2 seconds;

PULSE LENGTH was fixed at 0.4 seconds

TIME DOWN was fixed at 0.3 seconds

MAXIMUM VACUUM was fixed at a value of 80 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 0.9seconds.

The total wave time at each position of the applicator heads was 1.50min. The total wave time was 10 seconds (the wave was constituted by asingle pulse).

The total treatment time was 28 min.

b) Application of Long Pulse Stimuli with the Following Parameters.

The treatment was the same as in session 2, except for an increase of 10mbar in the MAXIMUM VACUUM which was possible because the patient's scarwas less painful after session 2:

TIME UP was fixed at 1 second;

PULSE LENGTH was fixed at 8 seconds

TIME DOWN was fixed at 1 second

MAXIMUM VACUUM was fixed at a value of 90 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 10seconds. The total wave time was 10 seconds (the wave was constituted bya single pulse).

The total treatment time was 12 min.

The results obtain after the three treatment sessions described abovecould be summarized as follows:

a) After treatment the patient presented a Grade 0 muscle tension iniliopsoas and adductor muscles and NO pain on palpation.

b) After treatment the patient presented Grade 0 presents miofascialmobility limitation in the iliopsoas and adductor muscles.

c) After treatment the patient presented NO adhesions in the superficialfascias which had full mobility.

Example 4: This Example Shows a Successful Treatment of a PatientReporting Pain and Limited Coxofemoral Movement in the Right Leg NotAssociated with a Degenerative Articular Process

Medical history: A 40 year old patient presents a 10 month old pain andlimited coxofemoral movement in the right leg (35° limitation in medialrotation). The screening tests exclude the existence of a degenerativearticular process

Assessment:

a) Muscle tension: the patient presents Grade 3 muscle tension in theright gluteus maximus and piriformis muscle (pain elicited on palpation)

b) Miofascial mobility: The patient presents Grade 3 limitation in theright gluteus maximus and piriformis muscle

c) Displacement of superficial fascia; The patient's superficial fasciashave no movement denoting the presence of adhesions.

Description of treatment: A treatment directed to the recovery of theconnective tissue associated with the articulation was applied. A 60minutes session was applied once a week until the range of movement wasnormalized. Normal rotation was achieved after four sessions.

Dosage Strength Used in the Four Sessions and Improvement Achieved inthe Range of Movement.

Session 1:

a) First, inhibition treatment was carried out. The patient was asked tolie in prone position on a treatment table with a 15 cm thick pillowunder his feet. The practitioner placed the applicators over the wholeextension of the gluteus maximus. Six applicator heads, each of 72 cm²were positioned in two parallel lines of three. A first series of vacuumstimuli was applied for a total wave time of 3 minutes. After theapplication of this first series of stimuli the practitioner moved allthe applicator heads 3 cm towards the head and a new series of stimuliwas applied for another total wave time of 3 minutes. After this secondseries the practitioner moved once more the applicator heads 3 cmtowards the head and repeated the 3 minute treatment. After havingapplied the above mentioned 3 series of vacuum stimuli the practitionermoved the applicators outwards 3 cm and administered another 3 minutetreatment. Then, the practitioner moved the applicators 3 cm towards thefeet and administered a new 3 minute treatment. Once completed, theapplicators were once again moved 3 cm towards the feet and the last 3minute treatment was applied. In total, 6 series of vacuum stimuli (asdescribed below) were applied for a total of 18 minutes covering thewhole area of the gluteus maximus and piriformis muscle (which liesunder the gluteus maximus) with the muscle in a relaxed position(inhibition).

For the above mentioned series of vacuum stimuli the parameters werefixed as follows:

TIME UP was fixed at 0.3 seconds;

PULSE LENGTH was fixed at 0.5 seconds

TIME DOWN was fixed at 0.3 second

MAXIMUM VACUUM was fixed at a value of 80 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 1.1seconds.

b) The next treatment step was an inhibition and stretch treatmentcarried out on the affected myofascial unit (gluteus maximus,piriformis). The patient was asked to stay in the same position (lyingprone). The practitioner used a mobile arm with a 72 cm² applicator andholds the tibia and the fibula with his free hand. The practitionerpositioned the head over the sacrum where the muscles to be treatedinsert and for 8 pulse stimuli did not move the applicator while keepingthe coxofemoral joint externally rotated (inhibition). After the eighthpulse stimulus the leg was slowly and progressively rotated internally(thus stretching the muscles under treatment) to their stretch limit.Meanwhile, with the applicator head still in position the practitionercontinued administering the treatment dose. At the end of the stretch,the practitioner kept the applicator in position and administered afurther 8 pulse stimuli. Then, the leg was slowly rotated externally andreturned to the initial position. Once the inhibition-stretch cycle wascompleted, the practitioner moved the applicator and repeated theprocedure until the whole length of the muscle had been treated. Thetotal treatment time was 10 minutes.

For the above mentioned series of vacuum stimuli the parameters werefixed as follows:

TIME UP was fixed at 0.3 seconds;

PULSE LENGTH was fixed at 0.5 seconds

TIME DOWN was fixed at 0.3 second

MAXIMUM VACUUM was fixed at a value of 80 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 1.1seconds.

c) The above mentioned treatment caused a great change at the pelvislevel: the pelvis presented itself as being blocked in retroversion.Thus, a compensatory treatment was carried out on the entire vertebralcolumn to ease its adaptation to the new position of the pelvis. Thestimuli were applied to the entire area of the paravertebral lumbarmuscles, in 4 series of vacuum stimuli (as described below) and totaltreatment time was 12 minutes.

For the above mentioned series of vacuum stimuli the parameters werefixed as follows:

TIME UP was fixed at 0.3 seconds;

PULSE LENGTH was fixed at 0.5 seconds

TIME DOWN was fixed at 0.3 second

MAXIMUM VACUUM was fixed at a value of 80 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 1.1seconds.

The patient showed no improvement in rotation at 8 days after the firstsession.

Session 2:

The treatment was the same as in session 1, except for an increase of 10mbar in the

The patient showed an improvement of 10° in rotation at 8 days after thefirst session leaving the limitation in medial rotation to a value of25°

Session 3:

The treatment was the same as in session 2, except for an increase of 10mbar in the

The patient showed an improvement of 15° in rotation at 8 days after thefirst session leaving the limitation in medial rotation to a value of10° (compared to an initial limitation of 35°).

The results obtain after the three treatment sessions described abovecould be summarized as follows:

After treatment the patient presented a Grade 0 muscle tension in theright gluteus maximus and piriformis muscle.

After treatment the patient miofascial mobility at the right gluteusmaximus and piriformis muscle showed no limitation.

Example 5: This Example Shows a Successful Treatment of a PatientReporting Pain in the in the Internal Area of the Left Knee

Medical history: A 35 year old patient presenting pain (VAS 7) in theinternal area of the left knee. Problem originated 3 months ago with ahistory of injury. Diagnostic screening has not found any of the tissuesto be ruptured. The practitioner found adhesions in the area of pain(internal capsule of the knee). In the painful area, the tissue does notmove during the sliding maneuver over the tissue planes and presentssticking/adhesion from the hypodermis level to the deeper tissue planes

Description of treatment: A treatment consisting of the application ofstretch to zone where adhesions are present was applied. The treatmentinvolved a 30 minutes session once a week applying vacuum stimuli. Thepain disappeared after two 30 minutes sessions.

Session 1:

A series of vacuum stimuli were applied characterized by the followingparameters:

TIME UP was fixed at 1 second;

PULSE LENGTH was fixed at 8 seconds

TIME DOWN was fixed at 1 second

MAXIMUM VACUUM was fixed at a value of 100 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 10seconds.

The total wave time was 10 seconds (the wave was constituted by a singlepulse).

The total treatment time was 10 min.

The patient showed an improvement in the pain sensation (VAS=3 after thefirst session).

Session 2:

The treatment was the same as in session 1, except for an increase of 20mbar in the MAXIMUM VACUUM and the duration of the treatment:

TIME UP was fixed at 1 second;

PULSE LENGTH was fixed at 8 seconds

TIME DOWN was fixed at 1 second

MAXIMUM VACUUM was fixed at a value of 120 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 10seconds. The total wave time was 10 seconds (the wave was constituted bya single pulse).

The total treatment time was 20 min.

The patient showed a complete remission of the pain sensation (VAS=0after the first session).

Example 6: Treatment of Adhesions and Scar Tissue Fibrosis

Medical history: 60 year old patient, operated on an inguinal hernia onthe left side, 12 months previously. Patient reports pain at theoperation site, worsening with movement and stretching (VAS 8); the scaris painful upon palpation.

Assessment:

-   -   a) Muscle tension: presents grade 3 muscle tension in the        iliopsoas and adductor muscles (pain elicited on palpation)    -   b) Myofascial mobility: presents grade 3 limitation in iliopsoas        and adductor muscles.    -   c) Displacement of superficial fascia; there is NO movement in        the superficial fascias (presence of adhesions).        Description of Treatment:

A one week 40 minutes session treatment is applied. After three sessionspain disappeared

Session 1:

TIME UP was fixed at 0.2 second;

PULSE LENGTH was fixed at 0.4 seconds

TIME DOWN was fixed at 0.3 second

MAXIMUM VACUUM was fixed at a value of 60 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 0.9seconds.

The total wave time at each position of the applicator heads was 1.5min.

The total treatment time was 7.5 min.

Two 17 cm² applicators were placed on the scar, one where the scarbegins and one in the middle of the scar. The above described protocolwas used for a total wave time of 1 minute and 30 seconds. Throughoutthe duration of the wave the applicators were not moved from the areawhere they were initially applied. Once the wave time has ended theapplicators are moved 1 cm along the line of the scar and the treatmentis applied again (1 min 30 sec). This is repeated until the wholeextension of the scar has been treated (the applicator which was at thebeginning of the scar ended up in the middle and the applicator whichbegan in the middle of the scar had been moved to the end of the scar.To cover the whole area of the scar 5 treatments were needed (totaltreatment time 7.5 minutes).

Then, the applicators were changed to applicators of a larger area (42cm²). One applicator was placed at the beginning of the scar and theother in the middle. The above-mentioned protocol was applied for atotal wave time of 1 minute and 30 seconds. Throughout the duration ofthe treatment the applicators were not moved from the area where theywere initially applied. Once the wave time has ended the applicatorswere moved 1 cm along the line of the scar and the treatment was appliedagain for another 1 min 30 sec. This process was repeated until thewhole extension of the scar had been treated (the applicator which wasat the beginning of the scar ended up in the middle and the applicatorwhich began in the middle of the scar had been moved to the end of thescar. To cover the whole area of the scar 5 treatments were needed(total treatment time 7.5 minutes).

After the treatment described above the fibrosis showed a clearimprovement; it is less hard and is less sensitive to touch.

b) Next, long pulse stimuli (with associated maneuvers to treatadhesions and fibrosis in the different planes) are applied.

TIME UP was fixed at 1 second;

PULSE LENGTH was fixed at 8 seconds

TIME DOWN was fixed at 1 second

MAXIMUM VACUUM was fixed at a value of 70 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 10seconds.

The total wave time was 10 seconds.

The total treatment time was 15 minutes

A 42 cm² applicator is used. The applicator was placed at the beginningof the scar; practitioner maneuvered the applicator and the tissue beingtreated in a northward direction during the “pulse length” (8 seconds).The objective was to stretch the different planes of the tissues thathave post surgery fibrosis and adhesions. After the total wave time, thepractitioner moved the applicator 1 cm along the scar and repeated theprocess until the whole length of the scar had been covered.

Once all the northward maneuvers are completed, the practitionerrepeated the process in a southward direction, then in an eastwarddirection and finally in a westward direction. It took 10 minutes tocomplete all the maneuvers.

Once the maneuvers on the fibrosis are completed the practitionerassessed whether the fibrotic tissue was movable. To do this, thepractitioner displaced the tissue under the applicator in 8 directions(north, northeast, east, southeast, south, southwest, west andnorthwest) during the “pulse length” cycle. This was done to determinewhether or not the tissue was able to move correctly or presentedlimitations when moved. The assessment showed that the patient presenteda limitation in the westward direction. Having determined the limitationwas in the westward direction, maneuvers were carried out to release theadhesions to regain normal movement. During the total wave time (10seconds) the practitioner maneuvered the applicator in a westwarddirection to stretch the fibres present in these planes, After the“total wave time” the practitioner moved the applicator 1 cm andrepeated the maneuver until the treatment had covered the entire area ofthe affected tissue under treatment. On termination of the precedingtreatment it was found that the maneuvers had been insufficient tochange the fibrotic tissue and so the treatment was repeated. However,after the second treatment of maneuvers on the fibrosis there was anotable improvement in the tissue with over 50% increased mobility inthe hypodermis and underlying planes. A treatment time of 5 minutes wasneeded.

Session 2: Dosage Strength Increased

a) First, short pulse stimuli were applied. As the patient reported lesspain than in the previous sesión the “Maximum vacuum” strength wasincreased by 10 mbars. For the rest the treatment was the same as insession 1, the only difference being a 10 mbar increment in order toattain greater depth and generate a greater biostimulus in the fibrotictissue.

TIME UP was fixed at 0.2 second;

PULSE LENGTH was fixed at 0.4 seconds

TIME DOWN was fixed at 0.3 second

MAXIMUM VACUUM was fixed at a value of 70 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 0.9seconds.

The total wave time at each position of the applicator heads was 1.5minutes.

b) Next, long pulse stimuli (with associated maneuvers for treatingfibrosis and adhesions between planes) were applied. The treatment wassimilar to the one applied during the second phase of sesión 1. Thestrength of “Maximum vacuum” was further increased by 10 mbars to atotal of 80 mbars. A treatment time of 13 minutes was applied.

TIME UP was fixed at 1 second;

PULSE LENGTH was fixed at 8 seconds

TIME DOWN was fixed at 1 second

MAXIMUM VACUUM was fixed at a value of 80 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 10seconds.

The total wave time at each position of the applicator heads was 1.5minutes.

Session 3: dosage strength and treatment time increased

a) First, short pulse stimuli were applied.

TIME UP was fixed at 0.2 seconds;

PULSE LENGTH was fixed at 0.4 seconds

TIME DOWN was fixed at 0.3 seconds

MAXIMUM VACUUM was fixed at a value of 80 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 0.9seconds.

The total wave time at each position of the applicator heads was 1.5minutes.

A treatment time of 7.5 min was applied.

b) Next, long pulse stimuli (with associated maneuvers for treatingadhesions between planes) were applied.

TIME UP was fixed at 1 second;

PULSE LENGTH was fixed at 8 seconds

TIME DOWN was fixed at 1 second

MAXIMUM VACUUM was fixed at a value of 90 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 10seconds.

The total wave time at each position of the applicator heads was 10seconds.

The total treatment time was 12 minutes.

Pain was assessed 8 days after the last one of the 3 session describedabove using the VAS scale (shown in FIG. 29) and a value of zero (0) wasobtained, i.e. the patient reported no pain.

The status of the affected zone (the scar) was assessed by apractitioner as herein above described and the following results wereobtained:

Muscle tension: presents muscle tension Grade 0 in iliopsoas andadductor muscles. (NO pain on palpation).

Miofascial mobility: presents Grade 0 limitation in the iliopsoas andadductor muscles.

Displacement of superficial fascias: there is mobility in thesuperficial fascias; there are NO adhesions present.

Example 7: Recovery of the Elastic Properties of the Connective Tissue

The example described below illustrates the beneficial effect of atreatment according to the invention when applied to the connectivetissue system, wherein the elasticity of the connective tissue isrestored. This improvement enables patients to recover movement infascia, in aponeurosis and in articulations that had lost their elasticproperties (due to age, training, overuse, repetitive movements,previous injury or otherwise), a loss that was considered normal and iscommonly considered irreversible.

Medical History: 40 year old patient presenting a 10 month old pain andlimited coxofemoral movement in the right leg (presents 35° limitationin medial rotation); screening tests exclude a degenerative articularprocess.

Assessment:

Muscle tension: presents Grade 3 muscle tension in the right gluteusmaximus and piriformis muscle (pain elicited on palpation)

Miofascial mobility: Presents Grade 3 limitation in the right gluteusmaximus and piriformis muscle.

The treatment methodology described in above for the treatment of themuscle and fascia system is used on the myofascial system of the gluteusmaximus and piriformis in order to recuperate movement in the connectivetissue and the muscle.

The treatment is applied, following the protocol described below, once aweek in 60 minutes session, until the range of movement is normalized;normal rotation is achieved after four treatments. To be effective thetreatment was applied over the whole area of the connective tissue undertreatment.

Session 1:

a) First, inhibition treatment was carried out on the affectedmyofascial unit. The patient was made to lie in prone position on thetreatment table with a 15 cm pillow under his feet. The practitionerplaced the fixed arm applicators over the whole extension of the gluteusmaximus (inferiorly from the sacrum passing over the area of the ischiumand superiorly from the gluteus medius to the insertion of the femur):six 72 cm² applicator heads were applied and were positioned in twoparallel lines of three.

The area was treated under the following protocol:

TIME UP was fixed at 0.3 seconds;

PULSE LENGTH was fixed at 0.5 seconds

TIME DOWN was fixed at 0.3 second

MAXIMUM VACUUM was fixed at a value of 80 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 1.1seconds.

The total wave time at each position of the applicator heads was 3 min

After the application of the first wave for a total wave time of 3 minthe practitioner moved all the applicators 3 cm towards the head and asecond wave was administered. After administration of the second wavewas finished the practitioner once again moved the applicators 3 cmtowards the head and administered a third 3 minutes wave. Afteradministration of the third wave was finished the practitioner onceagain moved the applicators 3 cm towards the head and administered afourth 3 minutes wave. After administration of the third wave wasfinished the practitioner moved the applicators 3 cm towards the feetand administers a fifth 3 minute wave. Once completed, the applicatorswere once again moved 3 cm towards the feet and the last 3 minute wavewas applied. In total, 6 waves of pulses were administered for a totaltreatment time of 18 minutes covering the whole area of the gluteusmaximus and piriformis muscle (which lies under the gluteus maximus)with the muscle in a relaxed position (inhibition).

b) Then, an inhibition and stretch treatment is carried out on theaffected myofascial unit (gluteus maximus, piriformis). The patientremained in the same position (lying prone). The practitioner used amobile arm with a 72 cm² applicator and held the tibia and fibula withtheir free hand. The practitioner positioned the head over the sacrumwhere the muscles to be treated insert and for 8 pulse stimuli did notmove the applicator while keeping the coxofemoral joint externallyrotated (inhibition). After the eighth pulse stimulus the leg was slowlyand progressively rotated internally (thus stretching the muscles undertreatment) to their stretch limit. Meanwhile, with the applicator headstill in position the practitioner continued administering the treatmentdose. At the end of the stretch, the practitioner kept the applicator inposition and administered a further 8 pulse stimuli. Then, the leg wasslowly rotated externally and returned to the initial position. Once theinhibition-stretch cycle was completed, the practitioner moved theapplicator and repeated the procedure until the whole length of themuscle had been treated. The treatment took 10 minutes.

c) The above mentioned treatment caused an important change in thestructure of the pelvis; which was blocked in retroversion. Thus, acompensatory treatment was carried out on the whole of the vertebralcolumn so that it may adapt to the new position of the pelvis. Therecuperation of connective tissue programme is applied to the entirearea of the paravertebral lumbar muscles for a treatment time 12minutes.

The patient showed no improvement in rotation at 8 days after the firstsession.

Session 2: The same treatment procedure as in Session 1 was applied witha 10 mbar increase in “Maximum vacuum”.

The area was treated under the following protocol:

TIME UP was fixed at 0.3 seconds;

PULSE LENGTH was fixed at 0.5 seconds

TIME DOWN was fixed at 0.3 second

MAXIMUM VACUUM was fixed at a value of 90 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 1.1seconds.

The total wave time at each position of the applicator heads was 3 min.

The patient showed an improvement in medial rotation 8 days after thesecond session of 10° gain in rotation wherein the initial 35°limitation was reduced to a 25° limitation.

Session 3: The same treatment procedure as in Session 1 was applied,with a 10 mbar increase in “Maximum vacuum” with respect to session 2.

The area was treated under the following protocol:

TIME UP was fixed at 0.3 seconds;

PULSE LENGTH was fixed at 0.5 seconds

TIME DOWN was fixed at 0.3 second

MAXIMUM VACUUM was fixed at a value of 100 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 1.1seconds.

The total wave time at each position of the applicator heads was 3 min.

The patient showed an improvement in medial rotation 8 days after thethird session of 15° gain in rotation wherein the initial 35° limitationwas reduced to a 10° limitation.

Session 4: The same treatment procedure as in Session 1 was applied,with a 10 mbar increase in “Maximum vacuum” with respect to session 3.

The area was treated under the following protocol:

TIME UP was fixed at 0.3 seconds;

PULSE LENGTH was fixed at 0.5 seconds

TIME DOWN was fixed at 0.3 second

MAXIMUM VACUUM was fixed at a value of 110 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 1.1seconds.

The total wave time at each position of the applicator heads was 3 min.

The patient showed an improvement in medial rotation 8 days after thefourth session of 10° gain in rotation wherein the initial 35°limitation was reduced to a 0° limitation.

The status of the affected zone was assessed by a practitioner as hereinabove described and the following results were obtained:

-   -   a) Muscle tension: Presents Grade 0 muscle tension in right        gluteus maximus and piriformis muscle.    -   b) Miofascial mobility: There is no limitation in the right        gluteus maximus and piriformis muscle.

Example 8: Removal of Adhesions Between Different Tissue Planes

Medical history: 35 year old patient reporting pain (VAS 7) in theinternal area of the left knee. Problem originated 3 months ago with ahistory of injury. Diagnostic screening has not found any of the tissuesto be ruptured. The practitioner found adhesions in the area of pain(internal capsule of the knee). In the painful area, the tissue does notmove during the sliding maneuver over the tissue planes and presentsadhesion from the hypodermis level to the deeper tissue planes.

Assessment:

Muscle tension: muscle tension Grade 0.

Miofascial mobility: presents Grade 0 limitation.

Superficial fascia displacement: There in NO mobility in the superficialfascias (indicating the presence of adhesions).

A treatment following the procedure outlined above in the sectiondevoted to the treatment of adhesions and scar tissue fibrosis section;combining short pulse stimuli and long pulse stimuli associated withmaneuvers, was applied to the painful area and its periphery. A weeklysession of 30 minutes was applied. The pain disappeared after the secondsession.

When the pulse length is administered the applicator head exerts suctionon the tissue under it thereby stretching the underlying planes. Duringthis time the practitioner maneuvers the applicator head to increase theangle of stretch of the underlying tissue planes. These maneuversmobilize the adhered planes and help release the adhesions presentbetween the different planes.

Dosage used in the two sessions and pain improvement achieved:

Session 1:

a) First, short pulse stimuli were applied to the painful area. This wasdone with the patient lying supine on the treatment bed. Thepractitioner placed two applicators (one of 42 cm² and the other of 25cm²) on the painful area via the fixed arms. A first wave was applied torelax the articular connective tissue, improve pliability of theadhesions and prime the area for the subsequent treatment of releasingthe adhesions.

TIME UP was fixed at 0.2 seconds;

PULSE LENGTH was fixed at 0.4 seconds

TIME DOWN was fixed at 0.3 second

MAXIMUM VACUUM was fixed at a value of 100 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 0.9seconds.

The total wave time at each position of the applicator heads was 1.5min.

A first 1.5 min wave was applied and then the applicators were displaced2 cm and a further 1.5 min wave was applied to the new area. The processwas repeated 3 more times so that in total 5 waves were applied coveringall the affected area. Thus, the total treatment time to cover the wholearea of the tissue under treatment was 7 minutes and 30 seconds.

b) As a second step, a treatment to release the adhesions isadministered. The treatment consisted in the application of waves formedby long pulse stimuli with the simultaneous application of maneuvers bythe practitioner to release adhesions with the following protocol:

TIME UP was fixed at 1 second;

PULSE LENGTH was fixed at 8 seconds

TIME DOWN was fixed at 1 second

MAXIMUM VACUUM was fixed at a value of 100 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 10seconds.

The practitioner used a 42 cm² applicator to apply the vacuum waves andto carry out the maneuvers for releasing adhesions. The maneuverscarried out by practitioner during the time of the “pulse length” wereas follows; the practitioner displaced the tissue underneath theapplicator in 8 directions (north, northeast, east, southeast, south,southwest, west and northwest) to assess whether the tissue moves orwhether it presents limitations upon displacement. The latter wouldconfirm the presence of adhesions. In this case, the patient presentedlimited movement in 2 directions (north and south). Having localized thelimitation the practitioner carried out maneuvers to release theadhesions. During the “Pulse length” (8 seconds), the practitionerdisplaced the tissues in a northward direction to stretch the adhesionspresent in this plane. Once the “Pulse length” ended and during “Timedown” the practitioner moved the applicator 1 cm and repeated thetreatment, this procedure was repeated until the entire length of thetissue had been treated. Once the treatment of releasing adhesions inthe northward direction was concluded it was repeated in a southwarddirection. These two treatments (maneuvers to release tissue north andsouth) had to be repeated 3 times in this patient, since the first twotreatments were not sufficient to achieve to release the adhesions.However, after 3 treatments with maneuvers to remove adhesions thetissue changed notably and movement improved in both the hypodermis andthe underlying planes by more than 50%. The total treatment time was 12minutes.

The patient reported a clear improvement in pain 8 days wherein the VASscore changed from the initial value of 7 to a value of 3.

Session 2:

a) In a first step, waves consisting of short pulse stimuli wereapplied. The same treatment procedure described for session 1 wasapplied, with a 10 mbar increment in “Maximum vacuum” with respect tosession 1.

TIME UP was fixed at 0.2 seconds;

PULSE LENGTH was fixed at 0.4 seconds

TIME DOWN was fixed at 0.3 second

MAXIMUM VACUUM was fixed at a value of 110 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 0.9seconds.

The total wave time at each position of the applicator heads was 1.5min.

b) In a second step waves consisting of long pulse stimuli were appliedby the practitioner while simultaneously carrying out maneuvers asdescribed for step b9 in session 1. The same treatment procedure insession 1 is applied, with a 10 mbar increment in “Maximum vacuum” withrespect to session 1.

TIME UP was fixed at 1 second;

PULSE LENGTH was fixed at 8 seconds

TIME DOWN was fixed at 1 second

MAXIMUM VACUUM was fixed at a value of 110 mbars

MINIMUM VACUUM was fixed at a value of 0 mbars

The total length of pulse (TIME UP+PULSE LENGTH+TIME DOWN) was 10seconds.

The total wave time at each position of the applicator heads was 1.5min.

The patient reported a clear improvement in pain 8 days wherein the VASscore changed from the value of 3 (reported after session 1) to a valueof 0, i.e. the patient reported to be pain-free.

The invention claimed is:
 1. A method of treating a tensional myofascialchain the tensional myofascial chain having a plurality of links anddominating an affected area where the patient is reporting symptomsselected from the group of muscular pain, fascial pain, inflammation,limitation of the joint articulation movement, and stenosis in thevascular, lymphatic or nervous systems, the tensional myofascial chainbeginning at an asymptomatic primary lesion and ending at a symptomaticlesion distal from the primary lesion, said method comprising; (i)identifying which link of the chain is the primary lesion, the primarylesion being the link within the tensional myofascial chain which is inthe most caudal position; and, (ii) treating the primary lesion byapplying a series of vacuum pulses, each of the vacuum pulsesrepresenting a series having a trapezoidal form when the vacuumintensity is represented in the Y axis and time is represented in the Xaxis.
 2. The method of claim 1, wherein the primary lesion gives rise toa chronic condition or incorrect structure in myofascial units andassociated structures in the human patient.
 3. The method of claim 1,wherein the identifying the tensional myofascial chain comprises: (i)placing the patient in a position to permit evaluation; (ii)anatomically locating an evaluation point to be examined in a link andpositioning at least one finger on an evaluation point; (iii) observingthe direction that the evaluation point moves; and (iv) determining ifthe evaluation point movement is correct or incorrect and the degree oftension in the link being evaluated.
 4. The method of claim 3, whereinthe position comprises standing, sitting or prone.
 5. The method ofclaim 3, wherein the observation of the direction that the evaluationpoint moves occurs when the patient stretches fascia.
 6. The method ofclaim 1, further comprising: (iii) after the treatment of step (ii)identifying a new primary lesion; (iv) treating the new primary lesion;(v) repeating steps (ii) and (iv) until no further lesion is detected.7. The method of claim 1 maintaining between each trapezoidal pulsevacuum at a value different than zero for a predetermined time period.8. The method according to claim 1, said method further comprisingtreating at least one other lesion in the chain different from theprimary lesion with a treatment step selected from the group of:decontraction of muscle and fascia; relieving tension in muscle andfascia fibers; relaxing sarcomerus; stretching and moving differentmuscle and fascial planes; and recovery of joint movement parameters. 9.The method according to claim 1, said method further comprising treatingthe symptomatic lesion distal from the primary lesion.
 10. The methodaccording to claim 1, said vacuum stimulus being administered using anapparatus comprising a support device comprising an arm structureassociated with a connecting member further comprising at least one hoseconnector associated with said arm structure and with at least one skintreatment machine applicator, said support device being suitable formaintaining the applicator at a given position when in use.